Misdiagnosis of rectal misplaced glands as rectal cancer: A rare case report

We report a rare case of rectal misplaced glands (RMG) with a 2-year disease course. Digital rectal examination identified a semi-circumferential mass approximately 4 cm from the anal verge. Imaging studies revealed irregular thickening of the middle and lower rectal walls with multiple mildly enlarged surrounding lymph nodes. Colonoscopic biopsy excluded a diagnosis of rectal cancer. Upon further evaluation of the patient's history, it was determined that chronic inflammation caused by prolonged soapstick enema use led to ectopic glandular proliferation within the rectal wall.

A 72-year-old female presented with a 2-year history of altered bowel habits and a 1-week history of anal fullness.

Imaging studies, including computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography, suggested rectal cancer. However, colonoscopic biopsy pathology revealed extensive inflammatory exudates, necrotic tissue, focal granulation tissue formation, and severe compression artifact. Considering the patient's 20-year history of soapstick enema use, clinicians diagnosed the condition as RMG.

The patient was advised to discontinue the use of soapstick enemas and was managed with regular follow-up and observation.

Misdiagnosis of RMG as rectal cancer could lead to unnecessary radical surgical interventions. Raising awareness of this rare condition and accurately interpreting pathological findings are critical to improving patient outcomes.

This case highlights the importance of considering rare conditions like RMG in the diagnosis of rectal masses. A detailed patient history, such as prolonged soapstick enema use, was crucial in identifying the cause. Imaging may suggest rectal cancer, but biopsy findings showing inflammation helped differentiate RMG.