Korean J Gastroenterol.  2016 Oct;68(4):214-217. 10.4166/kjg.2016.68.4.214.

A Case of Cecal Endometriosis Presenting as Subepithelial Tumor

• Hwang MS
• Kim YD
• Shin SY
• Jun JH
• Hong JS
• Eom DW
• Cheon GJ

• KMID: 2383518
• DOI: http://doi.org/10.4166/kjg.2016.68.4.214

Abstract

Endometriosis is a benign gynecologic disease, characterized by the presence and growth of functional endometrial-like tissue outside uterus. This ectopic endometrial tissue is most commonly found in the peritoneum, ovaries and uterosacral ligaments, but extremely rarely there is involvement of the appendix or cecum. Here we report a case of cecal endometriosis presenting as a subepithelial tumor diagnosed by surgical excision.

Keyword

Endometriosis; Colonic neoplasms

MeSH Terms

Appendix
Cecum
Colonic Neoplasms
Endometriosis*
Female
Genital Diseases, Female
Ligaments
Ovary
Peritoneum
Uterus

Figure

• 

  Fig. 1. (A) Upright view of the abdomen shows nonspecific bowel gas. (B) Abdomen pelvic CT (arrow) shows eccentric wall thickening and minimal infiltration on mesentery. (C) Endoscopic finding shows a 30 mm protruding lesion with mucosa on cecum.(D) Gross finding. A mass-like lesion is noted in the cecal wall, from submucosa to subserosa. The cut sur-faces of the lesion are whitish gray and solid. No hemorrhage or necrosis is present.

• 

  Fig. 2. (A, B) Some endometrial glands and stromal cells are noted in the submucosa and proper muscle of the colon (H&E; A, ×20 and B, ×100).(C, D) The endometrial glandular are positive for ER, and the stromal cells for CD10 (×100, immunohistochemistry).

Reference

References

1. Bulun SE. Endometriosis. N Engl J Med. 2009; 360:268–279.

2. Hasegawa T, Yoshida K, Matsui K. Endometriosis of the appendix resulting in perforated appendicitis. Case Rep Gastroenterol. 2007; 1:27–31.

3. Ijaz S, Lidder S, Mohamid W, Carter M, Thompson H. Intussusception of the appendix secondary to endometriosis: a case report. J Med Case Rep. 2008; 2:12.

4. Khoo JJ, Ismail MS, Tiu CC. Endometriosis of the appendix presenting as acute appendicitis. Singapore Med J. 2004; 45:435–436.

5. Podgaec S, Gonçalves MO, Klajner S, Abrão MS. Epigastric pain relating to menses can be a symptom of bowel endometriosis. Sao Paulo Med J. 2008; 126:242–244.

6. Tumay V, Ozturk E, Ozturk H, Yilmazlar T. Appendiceal endometriosis mimicking acute appendicitis. Acta Chir Belg. 2006; 106:712–713.

7. Al Oulaqi NS, Hefny AF, Joshi S, Salim K, Abu-Zidan FM. Endometriosis of the appendix. Afr Health Sci. 2008; 8:196–198.

8. Driman DK, Melega DE, Vilos GA, Plewes EA. Mucocele of the appendix secondary to endometriosis. Report of two cases, one with localized pseudomyxoma peritonei. Am J Clin Pathol. 2000; 113:860–864.

9. Gustofson RL, Kim N, Liu S, Stratton P. Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril. 2006; 86:298–303.

10. Giudice LC, Kao LC. Endometriosis. Lancet. 2004; 364:1789–1799.

11. Macafee CH, Greer HL. Intestinal endometriosis. A report of 29 cases and a survey of the literature. J Obstet Gynaecol Br Emp. 1960; 67:539–555.

12. Yantiss RK, Clement PB, Young RH. Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Am J Surg Pathol. 2001; 25:445–454.

13. Campagnacci R, Perretta S, Guerrieri M, et al. Laparoscopic colorectal resection for endometriosis. Surg Endosc. 2005; 19:662–664.

14. Bozdech JM. Endoscopic diagnosis of colonic endometriosis. Gastrointest Endosc. 1992; 38:568–570.

15. Valle RF, Sciarra JJ. Endometriosis: treatment strategies. Ann N Y Acad Sci. 2003; 997:229–239.

16. Emmanuel KR, Davis C. Outcomes and treatment options in rectovaginal endometriosis. Curr Opin Obstet Gynecol. 2005; 17:399–402.

17. Olive DL, Schwartz LB. Endometriosis. N Engl J Med. 1993; 328:1759–1769.

18. Ajossa S, Mais V, Guerriero S, et al. The prevalence of endometriosis in premenopausal women undergoing gynecological surgery. Clin Exp Obstet Gynecol. 1994; 21:195–197.