{"paper_id":"c8dd5f23-75ce-4093-b39a-88468435cfc5","body_text":"Cho YJ et al. Rectal endometriosis mimicking a large polypoid rectal cancer /C180Endoscopy 2006; 38: E48/C177E49\nEndometriosis is a disorder in which en−\ndometrial glandular tissue and stroma\nare found outside the uterus; it involves\nthe colorectum in about 5 % of cases [1,\n2].\nIt can occasionally be difficult to differ−\nentiate between colonic endometriosis,\nusually manifest as strictures or external\ncompression, and colon cancer or colitis\n[3]. In particular, the rare\npolypoid endo−\nmetriosis is hardly distinguishable from\ncolonic neoplasm [4]. More careful in−\nspection and diagnostic methods are\ntherefore required. We report a case of\nrectal polypoid\nendometriosis mimicking\na large polypoid rectal carcinoma.\nA 29−year−old woman presented with al−\nteration in bowel habit and intermittently\nblood−tinged stools over a period of\na few\nmonths. Colonoscopy revealed a large ul−\ncerating polypoid mass 8 cm from the\nanal verge which nearly obstructed the\nlumen (Figure 1). We\nthought that this\nwas a polypoid rectal adenocarcinoma.\nComputed tomography revealed an en−\nhancing soft−tissue mass with pericolic\ntumor infiltration, and bilateral cystic\nov\narian masses. Endoscopic biopsy, which\nwas performed on two separate occa−\nsions, showed chronic active inflamma−\ntion with granulation tissue and regen−\neration−type cytological atypia at first,\nand a hamartoma at the second biopsy.\nBecause rectal cancer could not be ruled\nout, the patient underwent low anterior\nresection and cystectomy. The mass w\nas\nattached to the rectal wall and was com−\nposed of multiple hemorrhagic, grayish\npolyps (Figure 2). Microscopic examina−\ntion showed endometrial glands and sur−\nrounding\nstroma, and a diagnosis of rectal\nendometriosis was made (Figure 3).\nPathological examination of the ovarian\ncysts showed an endometrioma on the\nright ov\nary and a corpus luteum cyst on\nthe left. A pericolic lymph node showed\nreactive hyperplasia.\nAlthough endometriosis is asymptomatic\nin many patients, rectosigmoid endome−\ntriosis\ncan result in changes in bowel hab−\nit. Magnetic resonance imaging has been\nproved to be valuable in the diagnosis of\nendometriosis [1]. If the colonic mucosa\nis not\ninvolved, the exact diagnosis might\nnot be made by colonoscopic biopsy [5].\nLaparotomy is a therapeutic option [2].\nEndoscopy_UCTN_Code_CCL_1AD_2AC\nRectal endometriosis mimicking a large\npolypoid rectal cancer\nDOI: 10.1055/s−2006−944678\nFigure 3 Histologi−\ncal examination of\nthe rectal mass\nshowed endometrial\nglands (arrow head)\nand surrounding\nstroma (arrow).\nFigure 2 Grossly,\nthe mass was found\nto be composed of\nmultiple hemorrhag−\nic grayish polyps and\nwas attached to the\nrectal wall.\nFigure 1 Colonoscopic view showing a\nlarge, ulcerating polypoid mass that was ob−\nstructing the lumen.\nU C T N\nUnusualcasesandtechnicalnotes\nE48\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.\n\n\nCho YJ et al. Rectal endometriosis mimicking a large polypoid rectal cancer /C180Endoscopy 2006; 38: E48/C177E49\nY. J. Cho, Y. T. Jeen, Y. S. Kim, H. J. Chun,\nS. H. Um, C. D. Kim, H. S. Ryu\nDepartment of Internal Medicine,\nInstitute of\nDigestive Disease and\nNutrition, Korea University College of\nMedicine, Seoul, Korea.\nReferences\n1\nOlive DL, Schwartz LB. Endometriosis. N Eng\nJ Med 1993; 328: 1759 /C1771769\n2\nJatan AK, Solomon MJ, Young J et al. Laparo−\nscopic management of rectal endometriosis.\nDis Colon Rectum 2005; 49: 1/C1776\n3\nYantiss RK, Clement PB, Young RH. Endome−\ntriosis of the intestinal tract: a study of 44\ncases of a disease that may cause\ndiverse\nchallenges in clinical and pathologic evalua−\ntion. Am J Surg Pathol 2001; 25: 445 /C177454\n4\nParker RL, Dadmanesh F, Young RH et al.\nPolypoid endometriosis: a clinicopathologic\nanalysis of 24 cases and a review of the\nlit−\nerature. Am J Surg Pathol 2004; 28: 285 /C177\n297\n5\nPaksoy M, Karabicak I, Ayan F et al. Intestinal\nobstruction due to rectal endometriosis. Mt\nSinai J Med 2005; 72: 405\n/C177408\nCorresponding Author\nY. T. Jeen, M. D.\nDepartment of Internal Medicine\nInstitute of Digestive Disease and\nNutrition\nKorea University College of Medicine\n126−1\nAnam−dong 5−ga, Seongbuk−gu\nSeoul 136−705\nKorea\nFax: +82−2−953−1943\nE−mail: kumcge@chol.com\nU C T N\nUnusualcasesandtechnicalnotes\nE49\nThis document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.","source_license":"public-domain-us","license_restricted":false}