{"paper_id":"57300586-4a8a-47cb-8f32-76e6deb3f5be","body_text":"Abstract\nIntestinal endometriosis exposed to the mucosa is relatively rare. Therefore, its endoscopic findings with pit pattern and magnifying endoscopy with narrow-band imaging and clinicopathological features of intestinal endometriosis exposed to the mucosa have not been well documented until now. A 44-year-old woman was suspected to have gastrointestinal bleeding by positive fecal occult blood test. Colonoscopy revealed a hemicircular submucosal tumor whose surface was covered with easy-bleeding papillary bulges in the rectum. Pit pattern analysis and magnifying endoscopy with narrow-band imaging revealed straight microvessels among the straight pits arranged in a radial manner, and the avascular area with no pit pattern of the top of the bulge. These findings were different from those of polyps or cancer. Biopsy specimens from the protruded lesions were diagnosed as rectal mucosal endometriosis by hematoxylin–eosin staining and immunohistochemical examination. Surgical resection was suggested to the patient, but the patient did not favor surgical treatment. After the diagnosis dienogest treatment started and successfully relieved her abdominal pain. Malignant transformation of the endometriotic lesion has not arisen to this date.\nSimilar content being viewed by others\nReferences\nWilliams TJ, Pratt JH. Endometriosis in 1,000 consecutive celiotomies: incidence and management. Am J Obstet Gynecol. 1977;129:245–50.\nJenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol. 1986;67:335–8.\nBergqvist A. Different types of extragenital endometriosis: a review. Gynecol Endocrinol. 1993;7:207–21.\nFrackiewicz EJ, Zarotsky V. Diagnosis and treatment of endometriosis. Expert Opin Pharmacother. 2003;4:67–82.\nRemorgida V, Ferrero S, Fulcheri E, et al. Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv. 2007;62:461–70.\nLanglois NE, Park KG, Keenan RA. Mucosal changes in the large bowel with endometriosis: a possible cause of misdiagnosis of colitis? Hum Pathol. 1994;25:1030–4.\nDimoulios P, Koutroubakis IE, Tzardi M, et al. A case of sigmoid endometriosis difficult to differentiate from colon cancer. BMC Gastroenterol. 2003;3:18.\nvan der Linden PJ. Theories on the pathogenesis of endometriosis. Hum Reprod. 1996;11(Suppl. 3):53–65.\nMilone M, Mollo A, Musella M, et al. Role of colonoscopy in the diagnostic work-up of bowel endometriosis. World J Gastroenterol. 2015;21:4997–5001.\nGarcia-Marin JA, Pellicer-Franco EM, Soria-Aledo V, et al. Malignant degeneration of rectal endometriosis. Rev Esp Enferm Dig. 2015;107:761–3.\nJiang W, Roma AA, Lai K, et al. Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases. Mod Pathol. 2013;26:1270–8.\nChen H, Luo Q, Liu S, et al. Rectal mucosal endometriosis primarily misinterpreted as adenocarcinoma: a case report and review of literature. Int J Clin Exp Pathol. 2015;8:5902–7.\nAcar T, Acar N, Celik SC, et al. Endometriosis within the sigmoid colon/extragenital endometriosis. Ulus Cerrahi Derg. 2015;31:250–2.\nHeaps JM, Nieberg RK, Berek JS. Malignant neoplasms arising in endometriosis. Obstet Gynecol. 1990;75:1023–8.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nShinsuke Kazama, Takeyuki Hiramatsu, Kenji Kuroda, Kumiko Hongo, Yukihiro Watanabe, Toshiaki Tanaka, and Ken Kuriki declare that they have no conflict of interest.\nHuman rights\nAll procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.\nInformed consent\nInformen consent was obtained from the patient for being included in this study.\nRights and permissions\nAbout this article\nCite this article\nKazama, S., Hiramatsu, T., Kuroda, K. et al. A case of unique endoscopic findings of intestinal endometriosis exposed to the mucosa: aggregation of papillary protruded bulges from the submucosal elevation of the rectum. Clin J Gastroenterol 12, 166–170 (2019). https://doi.org/10.1007/s12328-018-0912-y\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s12328-018-0912-y","source_license":"public-domain-us","license_restricted":false}