LOCAL ISCHEMIA CAUSES CARCINOMA-LIKE CHANGES OF THE RECTUM

PURPOSE: Bioptic specimens of typical cancerous changes in the rectum usually reveal signs of malignancy. Our goal was to describe the clini cal feature, histologic findings, and long-term outcome of patients in whom typical findings of carcinoma of the rectum were discovered by e ndoscopy, but whose histologic data did not confirm the diagnosis of a malignant disease. METHODS: We conducted a retrospective review of ei ght patients seen in our hospital with a clinical diagnosis of colorec tal cancer. RESULTS: AU patients had typical macroscopic findings of c olorectal cancer. Endoscopic examination was performed because of chro nic gastrointestinal symptoms (tenesmus, diarrhea, hematochezia, recur rent rectal prolapses; n = 5), incidental masses detected by rectal pa lpation (n = 2), or acute rectal bleeding (n = 1). Instead of confirmi ng malignancy, all histologic specimens showed typical signs of intest inal ischemia. In three patients, tumors were removed by endoscopy; th e other patients received symptomatic therapy. All patients were follo wed for an average period of 46 months. In five patients, symptoms dis appeared completely. Three patients continued to suffer from intestina l discomfort. In one case, progression of ischemic damage led to subto tal stenosis, which necessitated proctectomy. CONCLUSIONS: Our results indicate that, despite its rarity, ''ischemic pseudocarcinoma'' is an important differential diagnosis to cancer of the rectum. Prognosis i s generally good. Only patients suffering from chronic symptoms may re quire surgical treatment.