Endometriosis in the cecum diagnosed via forward-viewing endoscopic ultrasound-guided tissue acquisition with a 19G fine-needle biopsy needle: a case report

Kensei Kawasaki, Kotaro Takeshita, Shuta Otachi, Kenji Matsuo, Yuki Kano, Eisuke Nakao, Eisuke Akamine, Satoshi Asai
Clinical journal of gastroenterology · 2026 · doi:10.1007/s12328-026-02392-3 · PMID:42406283 · W7167507902
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Forward-viewing endoscopic ultrasound-guided tissue acquisition successfully diagnosed cecal endometriosis in a patient with a protruding lesion, enabling non-surgical management.

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This paper reports a single 30-year-old woman with a protruding cecal subepithelial lesion in whom colonoscopy suggested a subepithelial lesion, while CT showed a 37-mm contrast-enhancing mass and an adjacent suspected enlarged lymph node, raising differential diagnosis such as gastrointestinal stromal tumor. Using a forward-viewing echoendoscope advanced transanally to the cecum in 4 minutes, the authors performed endoscopic ultrasound-guided tissue acquisition (EUS-TA) with a 19-gauge needle for the cecal mass and a 25-gauge needle for the adjacent lesion, with histopathology and immunohistochemistry demonstrating endometrial glands and stroma positive for estrogen receptor, progesterone receptor, and CD10. The authors state the key limitation implied by the design is that it is a case report, and diagnostic and management generalizability is not established. This paper is centrally about endometriosis — specifically, endometriosis of the cecum diagnosed via forward-viewing EUS-guided tissue acquisition.

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Abstract

Subepithelial lesions (SELs) in the lower gastrointestinal tract are rare, and diagnosis and treatment of colorectal SELs are often challenging. Although endoscopic ultrasound-guided tissue acquisition (EUS-TA) is useful for minimally invasive histological diagnosis, few reports have described its use for right-sided colonic SELs because advancing an oblique-viewing echoendoscope into the right colon is difficult. A 30-year-old woman was referred to our hospital after colonoscopy revealed a protruding cecal lesion suggestive of an SEL. Contrast-enhanced computed tomography showed a 37-mm contrast-enhancing mass and an adjacent lesion, thought to be an enlarged lymph node, and gastrointestinal stromal tumor was suspected. A forward-viewing echoendoscope was inserted transanally and advanced successfully to the cecum in 4 min. EUS-TA of the cecal mass was performed using a 19-gauge fine-needle biopsy needle, and EUS-TA of the adjacent lesion was performed using a 25-gauge fine-needle biopsy needle. Histopathological and immunohistochemical examinations showed endometrial glands and stroma with positivity for estrogen receptor, progesterone receptor, and CD10, leading to a definitive diagnosis of endometriosis. This diagnosis enabled initial non-surgical management without immediate surgery.
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Abstract

Subepithelial lesions (SELs) in the lower gastrointestinal tract are rare, and diagnosis and treatment of colorectal SELs are often challenging. Although endoscopic ultrasound-guided tissue acquisition (EUS-TA) is useful for minimally invasive histological diagnosis, few reports have described its use for right-sided colonic SELs because advancing an oblique-viewing echoendoscope into the right colon is difficult. A 30-year-old woman was referred to our hospital after colonoscopy revealed a protruding cecal lesion suggestive of an SEL. Contrast-enhanced computed tomography showed a 37-mm contrast-enhancing mass and an adjacent lesion, thought to be an enlarged lymph node, and gastrointestinal stromal tumor was suspected. A forward-viewing echoendoscope was inserted transanally and advanced successfully to the cecum in 4 min. EUS-TA of the cecal mass was performed using a 19-gauge fine-needle biopsy needle, and EUS-TA of the adjacent lesion was performed using a 25-gauge fine-needle biopsy needle. Histopathological and immunohistochemical examinations showed endometrial glands and stroma with positivity for estrogen receptor, progesterone receptor, and CD10, leading to a definitive diagnosis of endometriosis. This diagnosis enabled initial non-surgical management without immediate surgery. Similar content being viewed by others

References

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Acknowledgements

We would like to thank all the medical staff at Tane General Hospital who were involved in this study and assisted with the endoscopic procedures. Funding None. Author information Authors and Affiliations Contributions KK: Writing—original draft. KT: Supervision, Writing—review & editing. SO, KM, YK, EN, EA and SA: Investigation. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Informed consent Informed consent was obtained from the patient for publication of her case details and the associated images. Animal or Human rights All procedures followed were in accordance with the ethical standards of the institutional and national guidelines and with the Helsinki Declaration of 1975, as revised in 2024. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Kawasaki, K., Takeshita, K., Otachi, S. et al. Endometriosis in the cecum diagnosed via forward-viewing endoscopic ultrasound-guided tissue acquisition with a 19G fine-needle biopsy needle: a case report. Clin J Gastroenterol (2026). https://doi.org/10.1007/s12328-026-02392-3 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s12328-026-02392-3

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