{"paper_id":"92c68c0b-8cc2-415a-8f03-a522ea42f124","body_text":"Abstract\nA rare case of endometriosis of the sigmoid with lymph node involvement is described in a 35-yea-rold patient. The patient presented with a 12-month history of abdominal pain and diarrhoea with catamenial aggravation. A full clinical and laboratory investigation was performed with normal results, with the exception of the tumour marker CA-125 which was elevated. An abdominal CT scan demonstrated an eccentric bowel wall thickening of the sigmoid colon. Colonoscopy revealed extensive stenosis of the bowel lumen covered by normal mucosa. The histopathology results of an endoscopic biopsy were inconclusive in regard to the nature of the obstruction. Preoperative assessment excluded colonic adenocarcinoma but could not rule out the possibility of a gastrointestinal stromal tumour (GIST) or other type of tumour. Nevertheless, the diagnosis of endometriosis appeared more likely. Intraoperatively, a solid, hard tumour of the sigmoid colon was palpated with a jejunal loop attached to it; consequently, sigmoidectomy for malignancy was decided as the optimal plan of action. There was no evidence of additional pathology in the abdominal cavity. Histology of the specimen revealed intramural endometriosis of the sigmoid with involvement of two regional nodes. Treatment options for large bowel endometriosis include hormonal manipulation with additional surgical resection depending on the patient’s age, the severity and the potential complications of the disease.\nSimilar content being viewed by others\nReferences\nCraig A. Winkel “Evaluation and Management of Women With Endometriosis” Obstetrics & Gynecology. 2003; 102(2): 397–408\nJubanyik KJ, Comite F. “Extrapelvic endometriosis.” Obstet Gynecol Clin North Am. 1997; 24(2):411–440\nPhilippos Dimoulios, Ioannis E Koutroubakis, Maria Tzardi, Pavlos Antoniou, Ioannis M Matalliotakis and Elias A Kouroumalis “A case of sigmoid endometriosis difficult to differentiate from colon cancer” BMC Gastroenterology 2003;3:18–22\nSievert W, Sellin JH, Stringer CA. “Pelvic endometriosis simulating colonic malignant neoplasm.” Arch Intern Med. 1989; 149(4):935–938.\nS. Mizrahi, O. Mayzler, D. Goldstein, R. Shaco-Levy “Endometriosis simulating a colonic obstructive neoplasm” European Journal of Surgical Oncology, 2003; 29(9):766–767\nScully R.E., Mark E.J. et al. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 13-2000. “A 26-year-old woman with bouts of abdominal pain, vomiting, and diarrhea.” N Engl J Med 2000; 27;342(17):1272–1278\nYantiss RK, Clement PB, Young RH.. “Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause d verse challenges in clinical and pathologic evaluation.” Am J Surg Pathol. 2001; 25(4):445–454\nInsabato L, Pettinato G. “Endometriosis of the bowel with lymph node involvement. A report of three cases and review of the literature.” Pathol Res Pract. 1996; 192(9):957–961; discussion 962\nAbrao MS, Podgaec S, Dias Jr JA, Averbach, M, Garry R, Luis Fernando Ferraz Silva, Carvalho FM. “Deeply infiltrating endometriosis affecting the rectum and lymph nodes” Fertility and Sterility 2006; 86(3):543–547\nYantiss RK, Clement PB, Young RH. Neoplastic and preneoplastic changes in gastrointestinal endometriosis: a study of 17 cases. Am J Surg Pathol. 2000; 24(4):513–524.\nCollin GR, Russell JC. “Endometriosis of the colon. Its diagnosis and management.” Am Surg. 1990; 56(5):275–279.\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(10):1030–1034\nBrosens J, Timmerman D, Starzinski-Powitz A, Brosens I. “Noninvasive diagnosis of endometriosis: the role of imaging and markers.” Obstet Gynecol Clin North Am. 2003; 30(1):95–114, viii–ix.\nGoncalves MO, Podgaec S, Dias JA Jr, Gonzalez M, Abrao MS. “Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy.” Hum Reprod. 2010 Mar;25(3):665–671.\nAyman Al-Talib & Togas Tulandi “Intestinal endometriosis” Gynecol Surg. 2010; 7:61–62\nZardawi I. “Aggressive endometriosis.” Int J Gynecol Cancer 2003; 13:98–100\nScolyer RA, Carter J, Russell P. “Aggressive endometriosis: report of a case.” Int J Gynecol Cancer. 2000; 10(3):257–262\nYan M, Boulas J, Russell P. “Aggressive endometriosis with focal change suggesting early neoplastic transformation.” Pathology. 2007; 39(4):450–453.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nMylonakis, E., Maroufidis, G., Klimis, A. et al. Deeply infiltrating endometriosis of the sigmoid and lymph nodes simulating obstructive neoplasm. Hellenic J Surg 82, 337–341 (2010). https://doi.org/10.1007/s13126-010-0053-3\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s13126-010-0053-3","source_license":"CC0","license_restricted":false}