A Case of Intestinal Endometriosis Diagnosed by Biopsy

Eiko Takeichi, Kosei Hamano, Osamu Noguchi
In: Progress of Digestive Endoscopy · 2017 · vol. 90(1) , pp. 120–121 · doi:10.11641/pde.90.1_120 · W2737152220
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This case report details the successful diagnosis of intestinal endometriosis in a patient with bloody stool via biopsy and immunohistochemistry, leading to conservative treatment with hormonal therapy.

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This case report describes a 25-year-old female presenting with bloody stool, fever, and abdominal pain who was initially treated for an infected ovarian endometriotic cyst. A subsequent colonoscopy revealed abnormalities in the rectosigmoid colon, leading to a biopsy that confirmed intestinal endometriosis through immunohistochemical markers showing estrogen receptor positivity and progesterone receptor positivity. The patient’s symptoms improved significantly after starting ultra-low-dose oral contraceptive therapy, demonstrating the efficacy of conservative management in this specific presentation. This paper is centrally about endometriosis — specifically the diagnostic challenges and successful conservative treatment of intestinal endometriosis.

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Abstract

A 25-year-old female with an endometriotic cyst on her left ovary came to our hospital, claiming she had bloody stool, fever, and abdominal pain. We diagnosed her with an endometriotic cyst infection and gave her antibiotics, which eased the condition. We also performed a colonoscopy to examine the bloody stool, in which we discovered a submucosal tumor and a pine cone-like elevation in her rectosigmoid colon. Based on the biopsy of the lesion, we diagnosed it as intestinal endometriosis because of ER (+) , PgR (+) , and CDX - 2 (-) . After the episode, the patient continued to have blood stool at each menstruation. Therefore, we put her on an ultra low dose birth-control pill, and the symptom has receded. It is hard to diagnose intestinal endometriosis by biopsy because of the location of the main lesion and the poor pathological characteristics in normal staining. However, in this case, by suspecting it from clinical course and communicating it to the pathologist, we could diagnose it from biopsy by adding immunostaining, enabling us to successfully treat it conservatively.
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症例 生検により確定診断に至った腸管子宮内膜症の1例 2017 年 90 巻 1 号 p. 120-121 詳細 抄録 A 25-year-old female with an endometriotic cyst on her left ovary came to our hospital, claiming she had bloody stool, fever, and abdominal pain. We diagnosed her with an endometriotic cyst infection and gave her antibiotics, which eased the condition. We also performed a colonoscopy to examine the bloody stool, in which we discovered a submucosal tumor and a pine cone-like elevation in her rectosigmoid colon. Based on the biopsy of the lesion, we diagnosed it as intestinal endometriosis because of ER (+) , PgR (+) , and CDX - 2 (-) . After the episode, the patient continued to have blood stool at each menstruation. Therefore, we put her on an ultra low dose birth-control pill, and the symptom has receded. It is hard to diagnose intestinal endometriosis by biopsy because of the location of the main lesion and the poor pathological characteristics in normal staining. However, in this case, by suspecting it from clinical course and communicating it to the pathologist, we could diagnose it from biopsy by adding immunostaining, enabling us to successfully treat it conservatively. © 2017 一般社団法人 日本消化器内視鏡学会 関東支部

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