A Case of Perineal Endometriosis with Findings Similar to Deeply Infiltrating Endometriosis by MRI

Kaori Tanaka, Takuo Nishina, Noriaki Kojima, Takahiro Mase, T. Mase, Hideki Mori
Nippon Daicho Komonbyo Gakkai Zasshi · 2019 · vol. 72(7) , pp. 439–443 · doi:10.3862/jcoloproctology.72.439 · W2954145673
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-13 ⓘ

This case study describes a 45-year-old woman diagnosed with perineal endometriosis presenting with a firm mass and pain, which responded well to hormonal therapy after MRI revealed a low-signal mass with punctate high-signal areas.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This case report describes a 45-year-old woman who developed an enlarging, cycle-associated painful induration in the perineum and was found on examination to have a 4 cm, poorly mobile mass beneath an episiotomy scar on the right side of the anal-vaginal area. MRI (T2WI) showed a low-signal mass with punctate high-signal foci, CA125 was elevated, and biopsy confirmed perineal endometriosis, with MRI suggesting broad invasion into the anal sphincter; the authors state that sphincter-preserving complete tumor excision was difficult and that hormonal therapy was chosen because she was near menopause with no desire for further pregnancy. After six months of hormonal treatment, MRI showed clear tumor shrinkage, CA125 decreased markedly, and perineal pain resolved. This paper is centrally about endometriosis — it reports a rare perineal (anal-vaginal) endometriosis case with MRI features resembling deeply infiltrating endometriosis.

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Abstract

症例は45歳女性で，4年前に第2子を出産後，肛門膣間に疼痛を伴う硬結を自覚していた．最近疼痛が増悪してきたため当科受診した．肛門膣間右側に分娩時の会陰切開痕を認め，直下に可動性のない径4cmの硬結を触知した．会陰部痛は月経周期に付随していた．CA125が高値を示し，MRI（T2WI）では低信号の腫瘤の内部に点状の高信号域を認めた．生検にて会陰部子宮内膜症と診断した．腫瘍が肛門括約筋に広く浸潤していたため，肛門機能を温存した腫瘍全摘は困難と判断．45歳と閉経に近く挙児希望がないことより，ホルモン療法を選択した．治療開始半年後のMRIでは明らかに腫瘍の縮小を認め，CA125も著減し，会陰部痛も消失した．会陰部異所性子宮内膜症はまれな疾患であるが，肛門診察で遭遇する可能性がある疾患である．本症例が非典型的なMRI所見を呈したこともあり，会陰部子宮内膜症のMRI所見についても考察する．
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症例報告 MRIで深部内膜症の所見を呈した会陰部子宮内膜症の1例 2019 年 72 巻 7 号 p. 439-443 詳細 抄録 症例は45歳女性で，4年前に第2子を出産後，肛門膣間に疼痛を伴う硬結を自覚していた．最近疼痛が増悪してきたため当科受診した．肛門膣間右側に分娩時の会陰切開痕を認め，直下に可動性のない径4cmの硬結を触知した．会陰部痛は月経周期に付随していた．CA125が高値を示し，MRI（T2WI）では低信号の腫瘤の内部に点状の高信号域を認めた．生検にて会陰部子宮内膜症と診断した．腫瘍が肛門括約筋に広く浸潤していたため，肛門機能を温存した腫瘍全摘は困難と判断．45歳と閉経に近く挙児希望がないことより，ホルモン療法を選択した．治療開始半年後のMRIでは明らかに腫瘍の縮小を認め，CA125も著減し，会陰部痛も消失した．会陰部異所性子宮内膜症はまれな疾患であるが，肛門診察で遭遇する可能性がある疾患である．本症例が非典型的なMRI所見を呈したこともあり，会陰部子宮内膜症のMRI所見についても考察する． © 2019 日本大腸肛門病学会 この記事はクリエイティブ・コモンズ [表示 - 非営利 - 改変禁止 4.0 国際]ライセンスの下に提供されています。 https://creativecommons.org/licenses/by-nc-nd/4.0/deed.ja

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endometriosis

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