title: Solitary rectal ulcer syndrome: a clinicopathological study of 13 cases.
abstract: OBJECTIVE
  Solitary rectal ulcer syndrome (SRUS) is a rare disorder that has a wide spectrum of clinical presentation and variable endoscopic findings. To further characterize the clinical and pathological features, a retrospective, hospital-based clinicopathological study was conducted.
  
  
  METHODS
  All cases of SRUS diagnosed at Farwania Hospital, Kuwait, between 2002 and 2007 were retrieved from the computerized filing system. The histological slides were reviewed by two authors to confirm the diagnosis. Immunohistochemical stain for smooth muscle actin (SMA) was performed. The clinical files were reviewed for clinical features and endoscopic findings.
  
  
  RESULTS
  Thirteen cases were identified: 8 males and 5 females. The age range was 15-85. Rectal bleeding, constipation, and abdominal pain were the most common presenting symptoms and were seen, either alone or in various combinations, in 12 of the 13 cases. Rectal ulceration was the most common endoscopic finding, being seen in 9 of the 3 cases; 3 of these cases had multiple ulcerations. Two patients had rectal polyps, with one of them having multiple polyps. The histological examination revealed surface serration, fibromuscular obliteration of the lamina propria, and crypts' distortion in all the cases. Seven of the cases had diamond crypts. Ectatic mucosal vessels were a common finding. Positivity for SMA in the lamina propria was seen in all examined cases.
  
  
  CONCLUSIONS
  SRUS is a rare disorder and only 13 cases were diagnosed in Farwania hospital over a 6-year period. The clinical presentation of our patients was variable. The presence of polyps and multiple ulcerations on endoscopy is further evidence that SRUS is a misnomer. Surface serration, fibromuscular obliteration, and crypts' distortion are the most characteristic features. The presence of diamond crypts is an additional diagnostic feature.
authors.affiliation: Department of Pathology, Farwania Hospital, Kuwait. nabeel.albrahim@gmail.com
authors.forename: Nabeel
authors.initials: N
authors.lastname: Al-Brahim
authors.forename: Naser
authors.initials: N
authors.lastname: Al-Awadhi
authors.forename: Saleh
authors.initials: S
authors.lastname: Al-Enezi
authors.forename: Saqer
authors.initials: S
authors.lastname: Alsurayei
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ahmad
mesh_terms: D000199:Actins / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012002:Rectal Diseases / Q000175:diagnosis* / Q000378:metabolism; D012189:Retrospective Studies; D013577:Syndrome; D014456:Ulcer / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D000199:Actins