Intestinal endometriosis diagnosed by mucosal cutting biopsy: a case report

Eriko Noma, Akinari Takao, Ryoko Shimizuguchi, Satomi Shibata, Shinichiro Horiguchi, Koichi Koizumi
In: Progress of Digestive Endoscopy · 2021 · vol. 98(1) , pp. 115–117 · doi:10.11641/pde.98.1_115 · W3181002570
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A mucosal cutting biopsy using a disposable endo-knife enabled the definitive diagnosis of intestinal endometriosis in a 46-year-old woman presenting with rectal submucosal tumor features and positive estrogen receptor staining.

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A 46-year-old female with a positive fecal occult blood test underwent evaluation for a submucosal tumor in the lower rectum. Imaging and endoscopic ultrasound identified an extramural mass, leading to a definitive diagnosis via mucosal cutting biopsy that revealed estrogen receptor-positive endometrial cells. The authors conclude that this biopsy technique, when combined with endoscopic ultrasound, provides a safe and effective method for obtaining sufficient tissue samples from submucosal tumors. This paper is centrally about intestinal endometriosis, specifically detailing the diagnostic utility of mucosal cutting biopsy for identifying deep infiltrating lesions in the rectum.

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Abstract

A 46-year-old, female patient was admitted to our hospital after testing positive on a fecal occult blood test. Colonoscopy revealed a submucosal tumor in the lower rectum with poor extension. Computed tomography and magnetic resonance imaging revealed a 23-mm, extramural mass with homogeneous enhancement. Endoscopic ultrasound showed an heterogeneous, hypo-echoic, extramural growth, mainly in the fourth layer of the intestinal mucosa. For definitive diagnosis, a mucosal cutting biopsy was performed using a disposable endo-knife. Pathological analysis of the biopsy specimen revealed endometrial cells that were positive for estrogen receptors. Based on this finding, intestinal endometriosis was diagnosed.
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症例 粘膜切開生検にて診断し得た腸管子宮内膜症の一例 2021 年 98 巻 1 号 p. 115-117 詳細 抄録 A 46-year-old, female patient was admitted to our hospital after testing positive on a fecal occult blood test. Colonoscopy revealed a submucosal tumor in the lower rectum with poor extension. Computed tomography and magnetic resonance imaging revealed a 23-mm, extramural mass with homogeneous enhancement. Endoscopic ultrasound showed an heterogeneous, hypo-echoic, extramural growth, mainly in the fourth layer of the intestinal mucosa. For definitive diagnosis, a mucosal cutting biopsy was performed using a disposable endo-knife. Pathological analysis of the biopsy specimen revealed endometrial cells that were positive for estrogen receptors. Based on this finding, intestinal endometriosis was diagnosed. Mucosal cutting biopsy can be used in conjunction with EUS to obtain a sufficient amount of tissue safely and is a useful diagnostic method for submucosal tumors such as in the present case. © 2021 一般社団法人 日本消化器内視鏡学会 関東支部

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