{"paper_id":"a5d18484-4738-4fc0-9c44-1a9bb922ca52","body_text":"Bowel endometriosis mimicking gastrointestinal\nstromal tumor and diagnosed by endoscopic\nultrasound\nA 51-year-old asymptomatic woman was\nreferred for colorectal cancer screening.\nDuring colonoscopy, a rectosigmoid sub-\nepithelial lesion was found, measuring\napproximately 2 cm and covered by nor-\nmal mucosa (\n●\" Fig. 1). An endoscopic ul-\ntrasound (EUS) was performed to evaluate\nthe lesion further. Radial and linear probes\nshowed a hypoechoic lesion, measuring\n22 × 9 mm, infiltrating the muscularis pro-\npria (\n●\" Fig. 2, ●\" Fig. 3 and ●\" Fig. 4). EUS-\nguided fine-needle aspiration (EUS-FNA)\nof the lesion was performed using a 22-\ngauge needle (\n●\" Fig. 5). Histopathological\nexamination showed the presence of en-\ndometrial glands and stroma (\n●\" Fig. 6).\nDifferentiating between subepithelial le-\nsions may be difficult during regular co-\nlonoscopic evaluation. EUS is the best\nimaging procedure to evaluate subepithe-\nlial lesions in the gastrointestinal tract [1].\nIt is possible to assess the size, layer of ori-\ngin, and the echotexture of the lesion, and\nto differentiate between an intramural\nand extramural lesion [2]. In most cases,\na hypoechoic lesion, infiltrating the mus-\ncularis propria, favors the diagnosis of a\ngastrointestinal stromal tumor (GIST).\nHowever, the rectosigmoid region can be\naffected by a wide variety of conditions,\nincluding tumors such as lymphoma, leio-\nmyoma, leiomyosarcoma, neuroendo-\ncrine tumor, and endometriosis.\nBowel endometriosis occurs in 3 % – 37 %\nof women with endometriosis [3]. Up to\n95 % of intestinal endometriosis is found\nin the rectum and sigmoid colon [4].\nDeep invasion of the intestinal wall is fre-\nFig. 3 Transrectal\nultrasound (TRUS,\nlinear probe): hypo-\nechoic lesion infiltrating\nthe muscularis propria\nof the rectosigmoid.\nFig. 2 Transrectal\nultrasound (TRUS,\nlinear probe): hypo-\nechoic lesion measuring\n22 × 9 mm.\nFig. 1 Colonoscopic view of the rectosigmoid\nsubepithelial lesion.\nFig. 4 Endoscopic\nultrasound images.\na Radial probe: hypo-\nechoic lesion infiltrating\nthe muscularis propria\nof the rectosigmoid.\nb Linear probe: hypo-\nechoic lesion infiltrating\nthe muscularis propria\nof the rectosigmoid.\nCases and Techniques Library (CTL) E433\nColaiacovo Rogerio et al. Bowel endometriosis mimicking GIST … Endoscopy 2014; 46: E433 –E434\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.\n\n\nquent, with infiltration of the muscularis\npropria or even of the submucosa. The\nmucosa is infiltrated in less than 5 % of\nintestinal lesions. An accurate evaluation\nis indispensable for therapeutic decisions,\nand laparoscopic surgical resection of\nendometriotic lesions is the treatment of\nchoice in symptomatic patients [5].\nIn the present case, it was possible to\nmake a diagnosis of bowel endometriosis\nmimicking GIST using endoscopic ultra-\nsound.\nEndoscopy_UCTN_Code_CCL_1AF_2AH\nCompeting interests: None\nRogerio Colaiacovo, Augusto Carbo-\nnari, Ricardo Ganc, Gustavo de Paulo,\nAngelo Ferrari\nHospital Israelita Albert Einstein,\nEndoscopy unit, São Paulo, Brazil\nReferences\n1 Landi B, Palazzo L. The role of endosonogra-\nphy in submucosal tumours. Best Pract Res\nClin Gastroenterol 2009; 23: 679 – 701\n2 Polkowski M , Butruk E . Submucosal lesions.\nGastrointest Endosc Clin N Am 2005; 15:\n33 – 54\n3 Williams TJ, Pratt JH. Endometriosis in 1,000\nconsecutive celiotomies: incidence and\nmanagement. Am J Obstet Gynecol 1977;\n129: 245 – 250\n4 Chapron C, Fauconnier A, Vieira M et al. Ana-\ntomical distribution of deeply infiltrating\nendometriosis: surgical implications and\nproposition for a classification. Hum Reprod\n2003; 18: 157 – 161\n5 Rossini LG , Ribeiro PA , Rodrigues FC et al.\nTransrectal ultrasound – techniques and\noutcomes in the management of intestinal\nendometriosis. Endosc Ultrasound 2012; 1:\n23 – 35\nBibliography\nDOI http://dx.doi.org/\n10.1055/s-0034-1377429\nEndoscopy 2014; 46: E433 –E434\n© Georg Thieme Verlag KG\nStuttgart · New York\nISSN 0013-726X\nCorresponding author\nAugusto Carbonari, MD\nEndoscopy Unit\nHospital Israelita Albert Einstein\nRua Manuel Figueiredo Landim 600\nSão Paulo\nBrazil 04693-130\nFax: +55-11-997787804\naugustocarbonari@gmail.com\nFig. 6 Pathological\nspecimen (hematoxylin\nand eosin stain) show-\ning endometrial glands\nand stroma.\nFig. 5 Endoscopic\nultrasound-guided\nfine-needle aspiration.\nColaiacovo Rogerio et al. Bowel endometriosis mimicking GIST … Endoscopy 2014; 46: E433 –E434\nCases and Techniques Library (CTL)E434\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.","source_license":"CC0","license_restricted":false}