Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases

Abstract

Endometriosis involving the mucosa of the intestines is rare, but may lead to diagnostic pitfalls. We reviewed 15 cases (seven biopsies and eight resections) from 14 patients. The patients' mean age is 48 years (31-66 years). Presenting symptoms included lower gastrointestinal bleeding, pelvic pain, rectal urgency, abdominal mass, and bowel obstruction. In the majority of cases, the lesion was located in the rectum (73%) with the remainder in the sigmoid colon (20%) and ileum (7%). The most common indication for biopsy was a polypoid lesion seen endoscopically (eight cases). For patients who underwent resections, the most common clinical impression was colonic carcinoma (75%), due to mass lesions and stricture as the most common macroscopic findings. Histologically, one case had stromal endometriosis only, but the remaining 14 cases had both endometrial glands and stroma. Epithelial metaplasia was present in all cases, mostly tubal metaplasia (ciliated epithelium). Hybrid glands and replacement of the surface epithelium by endometrial epithelium were also seen. Crypt architectural distortion, cryptitis, and crypt abscesses were seen in some cases, mimicking chronic active colitis or enteritis. A panel of immunohistochemical stains (CK7, CK20, CDX2, and ER) was found to be useful in biopsies with suspected endometriosis demonstrating unusual histology or only containing endometrioid stroma tissue. Vascular involvement by endometriosis was identified in one case. Endometrial hyperplasia (n ¼ 2) and cancer (n ¼ 1) were also seen in the ectopic tissue. All patients were alive at follow-up (3-216 months, mean 67 months).

Intestinal Endometriosis: Mimicker of Inflammatory Bowel Disease?

“…All 3 cases showed endometriotic mucosal involvement similarly to reports by other authors who underlined that cases with superficial involvement are those most often presenting with microscopic mucosal abnormalities [12,13] . This is probably secondary to surface erosions, which permit intestinal microbiota/fecal material to access the submucosa.…”

“…In a more recent study of 15 cases of IE involving the mucosa, crypt intestinal distortion was present in all cases, while cryptitis and crypt abscesses were present in 7 of 15 cases [13] . This study, however, focused differently from our consecutive IE series; selected, exclusively IE cases with mucosal involvement, in which mucosal inflammatory lesions occur more frequently than in IE on the whole were the focus of this study.…”

Thoracic endometriosis: clinicopathologic updates and issues about 18 cases from a tertiary referring center

“…In this setting, the endometrial glands are crowded and constituted of atypical cells carrying an irregular-shaped nucleus; in addition, the stromal cells may be less dense among the neoplastic glands. Lymphatic or hematogenous emboli do not represent a distinguishing feature because they may be found in the setting of endometriosis [23].…”

Endometriosis en colon sigmoides asociada a hematoquecia en una paciente histerectomizada

“…Aproximadamente el 10% de mujeres jóvenes (adolescentes y adultas jóvenes) pueden padecer endometriosis, como endometriosis peritoneal, endometrioma ovárico y endometriosis profunda infiltrante; esta última representa el 20% de los casos de endometriosis (6) .…”