Bowel endometriosis mimicking gastrointestinal stromal tumor and diagnosed by endoscopic ultrasound

Rogerio Colaiacovo, Rogério Colaiácovo, Colaiacovo R, Augusto Carbonari, Carbonari A, Ricardo Leite Ganc, Ganc R, Ricardo Ganc, de Paulo G, Gustavo De Paulo, Ferrari A, Ângelo Paulo Ferrari, Angelo Ferrari
Endoscopy · 2014 · vol. 46(S 01) , pp. E433–E434 · doi:10.1055/s-0034-1377429 · PMID:25314180 · W2318320437
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Endoscopic ultrasound-guided fine-needle aspiration diagnosed bowel endometriosis mimicking a gastrointestinal stromal tumor in a 51-year-old asymptomatic woman with a subepithelial rectosigmoid lesion.

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This case report describes evaluation of a 51-year-old asymptomatic woman undergoing colorectal cancer screening who had a rectosigmoid subepithelial lesion resembling a gastrointestinal stromal tumor. Colonoscopy identified a ~2 cm lesion covered by normal mucosa, and endoscopic ultrasound with radial and linear probes showed a hypoechoic lesion infiltrating the muscularis propria; endoscopic ultrasound-guided fine-needle aspiration was then performed. Histopathology demonstrated endometrial glands and stroma, leading to a diagnosis of bowel endometriosis that mimicked GIST, with the authors noting that subepithelial lesion differentiation can be difficult and that accurate imaging is important for therapeutic decisions, though the report is limited to a single patient. This paper is centrally about endometriosis — it documents bowel endometriosis in the rectosigmoid that was diagnosed via endoscopic ultrasound after mimicking a gastrointestinal stromal tumor.

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Abstract

A 51-year-old asymptomatic woman was referred for colorectal cancer screening. During colonoscopy, a rectosigmoid subepithelial lesion was found, measuring approximately 2 cm and covered by normal mucosa ([Fig. 1]). An endoscopic ultrasound (EUS) was performed to evaluate the lesion further. Radial and linear probes showed a hypoechoic lesion, measuring 22 × 9 mm, infiltrating the muscularis propria ([Fig. 2], [Fig. 3] and [Fig. 4]). EUS-guided fine-needle aspiration (EUS-FNA) of the lesion was performed using a 22-gauge needle ([Fig. 5]). Histopathological examination showed the presence of endometrial glands and stroma ([Fig. 6]).
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References

1 Landi B, Palazzo L. The role of endosonogra- phy in submucosal tumours. Best Pract Res Clin Gastroenterol 2009; 23: 679 – 701 2 Polkowski M , Butruk E . Submucosal lesions. Gastrointest Endosc Clin N Am 2005; 15: 33 – 54 3 Williams TJ, Pratt JH. Endometriosis in 1,000 consecutive celiotomies: incidence and management. Am J Obstet Gynecol 1977; 129: 245 – 250 4 Chapron C, Fauconnier A, Vieira M et al. Ana- tomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 2003; 18: 157 – 161 5 Rossini LG , Ribeiro PA , Rodrigues FC et al. Transrectal ultrasound – techniques and outcomes in the management of intestinal endometriosis. Endosc Ultrasound 2012; 1: 23 – 35

Bibliography

DOI http://dx.doi.org/ 10.1055/s-0034-1377429 Endoscopy 2014; 46: E433 –E434 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author Augusto Carbonari, MD Endoscopy Unit Hospital Israelita Albert Einstein Rua Manuel Figueiredo Landim 600 São Paulo Brazil 04693-130 Fax: +55-11-997787804 [email protected] Fig. 6 Pathological specimen (hematoxylin and eosin stain) show- ing endometrial glands and stroma. Fig. 5 Endoscopic ultrasound-guided fine-needle aspiration. Colaiacovo Rogerio et al. Bowel endometriosis mimicking GIST … Endoscopy 2014; 46: E433 –E434 Cases and Techniques Library (CTL)E434 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Colorectal Neoplasms Endometriosis Gastrointestinal Stromal Tumors Rectal Diseases Sigmoid Diseases Colorectal Neoplasms Diagnosis, Differential Endometriosis Endometriosis Endosonography Female Gastrointestinal Stromal Tumors Humans Middle Aged Rectal Diseases Rectal Diseases Sigmoid Diseases Sigmoid Diseases

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