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High grade nuclear atypia usually present Mucosal Prolapse / Cloacogenic Polyp (Localized Colitis Cystica Profunda) Lamina propria spindled lesion is smooth muscle actin negative and positive for perineurial markers Smooth muscle extends into lamina propria around crypts Mostly a spindled stromal lesion, crypts pushed aside Usually associated with ulcerative colitis but may be sporadic Not associated with inflammatory bowel disease Usually multiple, may involve any inflamed area

No smooth muscle in lamina propria of polyps Most have facial and oral papillomas, fibromas and skin tumors, see description LINK Smooth muscle in lamina propria usually not promiinent Prominent smooth muscle extension into lamina propria of polyps No prominent smooth muscle in lamina propria of polyps Smooth muscle extension into lamina propria of polyps Surface erosions with granulation tissue frequent Nuclei elongated, hyperchromatic, densely packed and frequently stratified Nuclei usually enlarged but round and not stratified and not densely packed Nuclear atypia most prominent deep in the lesion with surface maturation Prominent arborizing smooth muscle bundles surround groups of crypts Smooth muscle surrounds individual crypts

Smooth muscle actin stain shows thickened, distorted muscularis mucosae.

Located on edges of rectal mucosal folds.

May represent numerous small prolapse polyps.

Cap polyposis has been described in a few reports.

Cloacogenic polyp refers to a combination of the above features that gives rise to an inflammatory reactive polyp that appears hamartomatous (because of the mixture of glands and muscle).

Rare cases of prolapse apparently secondary to an adenoma.Maturation at surface is present, if not completely eroded.Adenomatous appearance is most marked in deep glands.Regenerating mucosal epithelium may appear adenomatous.May extend into lamina propria or submucosa.Mucus extravasation into stroma may be present.Has been termed localized colitis cystica profunda.Crypts may be elongated and straight or markedly distorted.Smooth muscle surrounds individual crypts.Thickened, disorganized muscularis mucosae with extension into lamina propria.Granulation tissue in high lamina propria.Capillary congestion and thrombosis usually present.Superficial ulceration or erosion of mucosa.May occur in sigmoid or higher or in stomas.Usually on anterior rectal wall within 12 cm of anal verge.A variety of changes may be seen secondary to rectal mucosal prolapse.

Histopathologic features of rectal mucosal prolapse ranging from ulceration to polyp formation.

Mucosal Prolapse / Cloacogenic Polyp Definition