Clinical Journal of Gastroenterology

, Volume 12, Issue 2, pp 166–170 | Cite as

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

  • Shinsuke KazamaEmail author
  • Takeyuki Hiramatsu
  • Kenji Kuroda
  • Kumiko Hongo
  • Yukihiro Watanabe
  • Toshiaki Tanaka
  • Ken Kuriki
Case Report


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.


Intestinal endometriosis Mucosal Endoscopy 


Compliance with ethical standards

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.

Human rights

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

Informed consent

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


  1. 1.
    Williams TJ, Pratt JH. Endometriosis in 1,000 consecutive celiotomies: incidence and management. Am J Obstet Gynecol. 1977;129:245–50.CrossRefGoogle Scholar
  2. 2.
    Jenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol. 1986;67:335–8.Google Scholar
  3. 3.
    Bergqvist A. Different types of extragenital endometriosis: a review. Gynecol Endocrinol. 1993;7:207–21.CrossRefGoogle Scholar
  4. 4.
    Frackiewicz EJ, Zarotsky V. Diagnosis and treatment of endometriosis. Expert Opin Pharmacother. 2003;4:67–82.CrossRefGoogle Scholar
  5. 5.
    Remorgida V, Ferrero S, Fulcheri E, et al. Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv. 2007;62:461–70.CrossRefGoogle Scholar
  6. 6.
    Langlois NE, Park KG, Keenan RA. Mucosal changes in the large bowel with endometriosis: a possible cause of misdiagnosis of colitis? Hum Pathol. 1994;25:1030–4.CrossRefGoogle Scholar
  7. 7.
    Dimoulios P, Koutroubakis IE, Tzardi M, et al. A case of sigmoid endometriosis difficult to differentiate from colon cancer. BMC Gastroenterol. 2003;3:18.CrossRefGoogle Scholar
  8. 8.
    van der Linden PJ. Theories on the pathogenesis of endometriosis. Hum Reprod. 1996;11(Suppl. 3):53–65.CrossRefGoogle Scholar
  9. 9.
    Milone M, Mollo A, Musella M, et al. Role of colonoscopy in the diagnostic work-up of bowel endometriosis. World J Gastroenterol. 2015;21:4997–5001.CrossRefGoogle Scholar
  10. 10.
    Garcia-Marin JA, Pellicer-Franco EM, Soria-Aledo V, et al. Malignant degeneration of rectal endometriosis. Rev Esp Enferm Dig. 2015;107:761–3.Google Scholar
  11. 11.
    Jiang W, Roma AA, Lai K, et al. Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases. Mod Pathol. 2013;26:1270–8.CrossRefGoogle Scholar
  12. 12.
    Chen H, Luo Q, Liu S, et al. Rectal mucosal endometriosis primarily misinterpreted as adenocarcinoma: a case report and review of literature. Int J Clin Exp Pathol. 2015;8:5902–7.Google Scholar
  13. 13.
    Acar T, Acar N, Celik SC, et al. Endometriosis within the sigmoid colon/extragenital endometriosis. Ulus Cerrahi Derg. 2015;31:250–2.Google Scholar
  14. 14.
    Heaps JM, Nieberg RK, Berek JS. Malignant neoplasms arising in endometriosis. Obstet Gynecol. 1990;75:1023–8.Google Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of Gastroenterological SurgerySaitama Cancer CenterKitaadachiJapan
  2. 2.Department of SurgeryYaizu Municipal HospitalYaizuJapan
  3. 3.Division of Surgical Oncology, Department of Surgery, Faculty of MedicineThe University of TokyoTokyoJapan
  4. 4.Department of GynecologyYaizu Municipal HospitalYaizuJapan
  5. 5.Department of GastroenterologyYaizu Municipal HospitalYaizuJapan
  6. 6.Department of PathologyYaizu Municipal HospitalYaizuJapan

Personalised recommendations