Endoscopy 2014; 46(S 01): E433-E434
DOI: 10.1055/s-0034-1377429
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Bowel endometriosis mimicking gastrointestinal stromal tumor and diagnosed by endoscopic ultrasound

Rogerio Colaiacovo
Hospital Israelita Albert Einstein, Endoscopy unit, São Paulo, Brazil
,
Augusto Carbonari
Hospital Israelita Albert Einstein, Endoscopy unit, São Paulo, Brazil
,
Ricardo Ganc
Hospital Israelita Albert Einstein, Endoscopy unit, São Paulo, Brazil
,
Gustavo de Paulo
Hospital Israelita Albert Einstein, Endoscopy unit, São Paulo, Brazil
,
Angelo Ferrari
Hospital Israelita Albert Einstein, Endoscopy unit, São Paulo, Brazil
› Author Affiliations
Further Information

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   

Publication History

Publication Date:
14 October 2014 (online)

 

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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Fig. 1 Colonoscopic view of the rectosigmoid subepithelial lesion.
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Fig. 2 Transrectal ultrasound (TRUS, linear probe): hypoechoic lesion measuring 22 × 9 mm.
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Fig. 3 Transrectal ultrasound (TRUS, linear probe): hypoechoic lesion infiltrating the muscularis propria of the rectosigmoid.
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Fig. 4 Endoscopic ultrasound images. a Radial probe: hypoechoic lesion infiltrating the muscularis propria of the rectosigmoid. b Linear probe: hypoechoic lesion infiltrating the muscularis propria of the rectosigmoid.
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Fig. 5 Endoscopic ultrasound-guided fine-needle aspiration.
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Fig. 6 Pathological specimen (hematoxylin and eosin stain) showing endometrial glands and stroma.

Differentiating between subepithelial lesions may be difficult during regular colonoscopic evaluation. EUS is the best imaging procedure to evaluate subepithelial lesions in the gastrointestinal tract [1]. It is possible to assess the size, layer of origin, and the echotexture of the lesion, and to differentiate between an intramural and extramural lesion [2]. In most cases, a hypoechoic lesion, infiltrating the muscularis propria, favors the diagnosis of a gastrointestinal stromal tumor (GIST). However, the rectosigmoid region can be affected by a wide variety of conditions, including tumors such as lymphoma, leiomyoma, leiomyosarcoma, neuroendocrine tumor, and endometriosis.

Bowel endometriosis occurs in 3 % – 37 % of women with endometriosis [3]. Up to 95 % of intestinal endometriosis is found in the rectum and sigmoid colon [4]. Deep invasion of the intestinal wall is frequent, with infiltration of the muscularis propria or even of the submucosa. The mucosa is infiltrated in less than 5 % of intestinal lesions. An accurate evaluation is indispensable for therapeutic decisions, and laparoscopic surgical resection of endometriotic lesions is the treatment of choice in symptomatic patients [5].

In the present case, it was possible to make a diagnosis of bowel endometriosis mimicking GIST using endoscopic ultrasound.

Endoscopy_UCTN_Code_CCL_1AF_2AH


#

Competing interests: None

  • References

  • 1 Landi B, Palazzo L. The role of endosonography 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. Anatomical 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

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   

  • References

  • 1 Landi B, Palazzo L. The role of endosonography 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. Anatomical 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

Zoom Image
Fig. 1 Colonoscopic view of the rectosigmoid subepithelial lesion.
Zoom Image
Fig. 2 Transrectal ultrasound (TRUS, linear probe): hypoechoic lesion measuring 22 × 9 mm.
Zoom Image
Fig. 3 Transrectal ultrasound (TRUS, linear probe): hypoechoic lesion infiltrating the muscularis propria of the rectosigmoid.
Zoom Image
Fig. 4 Endoscopic ultrasound images. a Radial probe: hypoechoic lesion infiltrating the muscularis propria of the rectosigmoid. b Linear probe: hypoechoic lesion infiltrating the muscularis propria of the rectosigmoid.
Zoom Image
Fig. 5 Endoscopic ultrasound-guided fine-needle aspiration.
Zoom Image
Fig. 6 Pathological specimen (hematoxylin and eosin stain) showing endometrial glands and stroma.