ANALYSIS OF THE CHARACTERISTICS OF INTESTINAL ENDOMETRIOSIS LESIONS WITH RECTAL INVOLVEMENT USING THREE-DIMENSIONAL ENDOANAL ULTRASOUND

Case presentation A 33-year-old male presented with a three-year history of hematochezia, tenesmus, and anal prolapse.The condition progressed with worsening anal bleeding, requiring blood transfusion.He sought medical attention, and a colonoscopy revealed an arteriovenous malformation 2 cm above the pectinate line.Despite treatment, the symptoms persisted, and the bleeding worsened.He was referred to a specialized center with a provisional diagnosis of hemorrhoidal disease.A proctological examination under sedation was performed, revealing a bleeding, pedunculated lesion measuring 6 cm, located above the pectinate line.Local excision of the lesion was performed.Histopathological analysis showed intramucosal adenocarcinoma associated with a villous adenoma with high-grade dysplasia, with clear surgical margins.Discussion Primary adenocarcinoma of the anus is a rare disease accounting for only 5%-10% of anal canal malignancies.The presentation of this disease is generally late, with a mean age of diagnosis at 59 years, possibly due to the associated non-specific symptoms.Anal adenocarcinomas can be subdivided into two types: (1) colorectal from the mucosa above the dentate line and (2) extramucosal from anorectal fistulas or anal glands.Given the challenges with classification and the low number of cases overall, most of the literature is limited to case reports or outcome-driven observational studies.This case highlights the challenges of early diagnosis of anal malignancies and the importance of immediate evaluation of the anorectal region when recto-anal symptoms, such as bleeding or mucus in the stool, are reported through digital rectal examination, sometimes neglected in medicine.The lesion presented a clinical picture similar to symptoms of hemorrhoidal disease, such as bleeding and anal prolapse.Anal tumors can also be identified in routine or diagnostic colonoscopy, even in asymptomatic patients.Conclusion Due to delayed diagnosis, anal adenocarcinomas often have a poor prognosis.Understanding the patient's symptoms and performing a physical examination, such as a digital rectal exam, supports early diagnosis and targeted treatment.This approach contributes to better patient outcomes and helps reduce the morbidity and mortality associated with the disease.