{"paper_id":"3203b145-ea7c-4823-a23f-bc19a473da72","body_text":"A case of rectal bleeding caused by digestive\nendometriosis resembling colon cancer\nA 42-year-old unmarried, nulliparous\nwoman presented at our hospital with\nrectal bleeding. The patient had had iron\ndeficiency anemia in the past. She had\nnormal, regular menses with mild dysme-\nnorrhea and had not taken hormonal\ndrugs. Her physical examination was un-\nremarkable. Colonoscopy revealed wide-\nspread polypoid mucosal thickening and\nluminal narrowing, along with erythema\nand edema, in the sigmoid colon. It was\nnot possible to pass the endoscope be-\nyond the lesion (\n●\" Fig. 1). Multiple endo-\nscopic biopsies were taken, but histopa-\nthologic examination was nondiagnostic.\nAn abdominal computed tomography\n(CT) scan revealed eccentric thickening of\nthe wall of the sigmoid colon (\n●\" Fig. 2).\nThe patient proceeded to laparotomy,\nwhich revealed that the lesion had pene-\ntrated the sigmoid colon to the posterior\nuterine wall. Segmental resection of the\nsigmoid colon with side-to-side anasto-\nmosis was performed. On pathological ex-\namination, beneath a 4-cm fleshy-grey\npolypoid mass, the colonic wall was thick-\nened over a 5-cm length (\n●\" Fig. 3).\nMicroscopy revealed polypoid endo-\nmetriosis of the bowel. Native colonic\nmucosa was also observed around the\nareas of endometriosis (\n●\" Fig. 4).\nIntestinal endometriosis penetrating the\nbowel wall may lead to localized narrow-\ning and obstruction [1]. Polypoid endo-\nmetriosis is a rare variant of endometrio-\nsis that is characterized by multiple large\npolypoid masses that may resemble ma-\nlignancies.\nEndoscopic ultrasound (EUS) can be used\nto determine the size, margins, and layer\nof origin, as well as additional morpholo-\ngic features that can suggest the endome-\ntriosis. A hypoechoic lesion infiltrating\nthe muscularis propria and the serosa of\nthe rectal wall and extending outside the\nrectal wall may be seen during EUS [2].\nThe endoscopic appearance of the mucosa\nis not diagnostic, and endoscopic biopsies\ncommonly yield specimens that are insuf-\nficient for pathologic diagnosis [3]. EUS-\nguided fine needle aspiration (FNA) can\nbe useful in the evaluation of recto-\nsigmoid endometriosis [4]. Surgery is the\ngold-standard diagnostic method for\nendometriosis [5].\nEndoscopy_UCTN_Code_CCL_1AD_2AD\nFig. 2 Oral and intra-\nvenous contrast-en-\nhanced computed to-\nmography (CT) image\n(axial view) showing dif-\nfuse and irregular thick-\nening of the wall of the\nsigmoid colon.\nFig. 1 Endoscopic view showing polypoid\nendometriosis of the colonic mucosa.\nFig. 4 Microscopic\nview of the resected\nspecimen stained im-\nmunohistochemically\nfor CD10 showing posi-\ntive staining of the\nendometrial stroma\n(magnification × 40).\nFig. 3 Macroscopic view of the resected sig-\nmoid colon showing the thickened, fibrotic\nwall, which was bright white in the areas where\nendometriosis was found.\nCases and Techniques Library (CTL) E357\nYilmaz Bulent et al. Digestive endometriosis resembling colon cancer … Endoscopy 2014; 46: E357 –E358\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.\n\n\nCompeting interests: None\nBulent Yilmaz1, Selma Cukur2,\nRula Sahin3\n1 Department of Gastroenterology, Bolu\nIzzet Baysal State Hospital, Bolu, Turkey\n2 Department of Pathology, Bolu Izzet\nBaysal State Hospital, Bolu, Turkey\n3 Department of Radiology, Bolu Izzet\nBaysal State Hospital, Bolu, Turkey\nReferences\n1 Schwartz JL , Schwartz LB . Extrapelvic endo-\nmetriosis. In: Diamond MP, Osteen KG, eds.\nEndometrium and Endometriosis. Maden,\nMassachusetts: Blackwell Science; 1997:\n247 – 254\n2 Pishvaian AC , Ahlawat SK , Garvin D et al.\nRole of EUS and EUS-guided FNA in the diag-\nnosis of symptomatic rectosigmoid endo-\nmetriosis. Gastrointest Endosc 2006; 63:\n331 – 335\n3 Parker RL , Dadmanesh F , Young RH et al.\nPolypoid endometriosis: a clinicopathologic\nanalysis of 24 cases and a review of the lit-\nerature. Am J Surg Pathol 2004; 28: 285 –\n297\n4 Bhutani MS . Recent developments in the\nrole of endoscopic ultrasonography in dis-\neases of the colon and rectum. Curr Opin\nGastroenterol 2007; 23: 67 – 73\n5 Buchweitz O, Poel T, Diedrich K et al. The di-\nagnostic dilemma of minimal and mild en-\ndometriosis under routine conditions. J Am\nAssoc Gynecol Laparosc 2003; 10: 85 – 89\nBibliography\nDOI http://dx.doi.org/\n10.1055/s-0034-1377378\nEndoscopy 2014; 46: E357 –E358\n© Georg Thieme Verlag KG\nStuttgart · New York\nISSN 0013-726X\nCorresponding author\nBulent Yilmaz, MD\nBolu Izzet Baysal State Hospital\nDepartment of Gastroenterology\nPK: 14280\nBolu\nTurkey\nFax: +90-374-2534615\nyilmazb76@mynet.com\nYilmaz Bulent et al. Digestive endometriosis resembling colon cancer … Endoscopy 2014; 46: E357 –E358\nCases and Techniques Library (CTL)E358\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.","source_license":"CC0","license_restricted":false}