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A case of unique endoscopic findings of intestinal endometriosis exposed to the mucosa: aggregation of papillary protruded bulges from the submucosal elevation of the rectum

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Abstract

Intestinal endometriosis exposed to the mucosa is relatively rare. Therefore, its endoscopic findings with pit pattern and magnifying endoscopy with narrow-band imaging and clinicopathological features of intestinal endometriosis exposed to the mucosa have not been well documented until now. A 44-year-old woman was suspected to have gastrointestinal bleeding by positive fecal occult blood test. Colonoscopy revealed a hemicircular submucosal tumor whose surface was covered with easy-bleeding papillary bulges in the rectum. Pit pattern analysis and magnifying endoscopy with narrow-band imaging revealed straight microvessels among the straight pits arranged in a radial manner, and the avascular area with no pit pattern of the top of the bulge. These findings were different from those of polyps or cancer. Biopsy specimens from the protruded lesions were diagnosed as rectal mucosal endometriosis by hematoxylin–eosin staining and immunohistochemical examination. Surgical resection was suggested to the patient, but the patient did not favor surgical treatment. After the diagnosis dienogest treatment started and successfully relieved her abdominal pain. Malignant transformation of the endometriotic lesion has not arisen to this date.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Saitama Cancer Center, 780, Komuro, Ina, Kitaadachi, Saitama, 362-0806, Japan

    Shinsuke Kazama

  2. Department of Surgery, Yaizu Municipal Hospital, 1000 Dobara, Yaizu, Shizuoka, 425-8505, Japan

    Shinsuke Kazama, Takeyuki Hiramatsu & Kumiko Hongo

  3. Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Shinsuke Kazama & Toshiaki Tanaka

  4. Department of Gynecology, Yaizu Municipal Hospital, 1000 Dobara, Yaizu, Shizuoka, 425-8505, Japan

    Kenji Kuroda

  5. Department of Gastroenterology, Yaizu Municipal Hospital, 1000 Dobara, Yaizu, Shizuoka, 425-8505, Japan

    Yukihiro Watanabe

  6. Department of Pathology, Yaizu Municipal Hospital, 1000 Dobara, Yaizu, Shizuoka, 425-8505, Japan

    Ken Kuriki

Authors
  1. Shinsuke Kazama
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  2. Takeyuki Hiramatsu
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  3. Kenji Kuroda
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  4. Kumiko Hongo
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  5. Yukihiro Watanabe
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  6. Toshiaki Tanaka
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  7. Ken Kuriki
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Corresponding author

Correspondence to Shinsuke Kazama.

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Conflict of interest

Shinsuke Kazama, Takeyuki Hiramatsu, Kenji Kuroda, Kumiko Hongo, Yukihiro Watanabe, Toshiaki Tanaka, and Ken Kuriki declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informen consent was obtained from the patient for being included in this study.

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Kazama, S., Hiramatsu, T., Kuroda, K. et al. A case of unique endoscopic findings of intestinal endometriosis exposed to the mucosa: aggregation of papillary protruded bulges from the submucosal elevation of the rectum. Clin J Gastroenterol 12, 166–170 (2019). https://doi.org/10.1007/s12328-018-0912-y

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  • DOI: https://doi.org/10.1007/s12328-018-0912-y

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