PMC3686071_01
(a) Kidneys, Ureters, and Bladder (KUB) imaging shows numerous venous calcifications consistent with phleboliths from vascular abnormalities in pelvic area (white arrows). (b) and (c) Computed Tomography (CT) scan of the abdomen and pelvis shows markedly thickened colonic (rectal) wall (yellow arrows).
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Kidneys, ureters, and bladder (KUB) X-ray revealed multiple small rounded calcifications throughout the lower abdomen (Figure 1(a)). Computed tomography (CT) scan of the abdomen and pelvis showed marked wall thickening in the left colon, sigmoid colon, and the rectum (Figures 1(b) and 1(c)).
Colonoscopy shows (a) varicose veins (blue arrows) in the rectum and (b) varicose veins (blue arrows) and blood at the hepatic flexure.
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Subsequent colonoscopy showed long, large, and dilated tortuous veins throughout the colon, with large amount of red and clotted blood extending to the ascending colon (Figures 2(a) and 2(b)).
Resected colon (gross) shows (a) colonic mucosa having a nodular surface (asterisks) caused by dilated vascular spaces in the underlying bowel wall. The purple arrow indicates a large lymphatic space in the submucosa which has distorted the overlying mucosa; (b) section through the bowel wall demonstrates dilated blood vessels in the submucosa (red arrow) and muscularis propria (black arrow); (c) and (d) external surface of the resected colon has congested dilated blood vessels consisting of prominent varices on the serosal surface (green arrows).
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Grossly, the resected left colon and rectum showed extensive mucosal varicoses with nodular changes (Figure 3(a)). The wall was markedly thickened, and the mucosal surface was reddish-pink in color (Figures 3(a) and 3(b)). The serosal surface showed markedly dilated veins with prominent varices (Figures 3(c) and 3(d)).
Microscopic examination of the resected colonic segment shows (a) section through the colonic wall which has several dilated blood vessels distorting the serosal surface (black arrowheads) (H&E stain, 10x); (b) several dilated lymphovascular structures in the lamina propria and in the submucosal layers of the colonic wall (black dots) (H&E stain, 10x); (c) and (d) dilated submucosal blood vessels with luminal thrombosis (black squares) (H&E stain, 10x).
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Histological examination of the resected area showed extensive venous malformations and dilated lymphatics with focal thrombosis consistent with KTS (Figure 4).