Cecal Endometriosis With Intestinal Metaplasia Misdiagnosed as Neoplasm of the Cecum by Intraoperative Histological Examination

Colorectal endometriosis - a challenging, often overlooked cause of colorectal pathology: a clinicopathological review of 114 cases

The colon is the most common site for endometriosis outside the genital tract. It has a varied presentation and can mimic numerous other conditions, both clinically and pathologically. We investigated the clinicopathological features of a series of colorectal endometriosis with a particular emphasis on the features seen in cases with colonic mucosal involvement. A total of 114 consecutive cases of colorectal endometriosis were reviewed. Forty-eight percent did not have a prior diagnosis of endometriosis and in 34 patients (30%) the endometriosis was determined as the cause for the presentation. Mucosal involvement was present in 31 specimens. Features of chronic colitis were seen in the adjacent mucosa in 90% of cases whilst there were glandular changes mimicking adenocarcinoma in two cases (1.8%). Fifty percent of cases with mucosal involvement also showed glands with a hybrid intestinal-endometrial phenotype by morphology and/or by immunohistochemistry. Endometriosis is an important mimic of other conditions.

Endometriosis in the Cecum: A Rare Clinical Entity

Cecal endometriosis is uncommon and may mimic other tumors of the colon, making it difficult to safely diagnose preoperatively. We report a case of a 50- year-old female who was found to have a cecal lesion during an endoscopic examination, which was performed for the investigation of anemia. It was also confirmed by conducting a computed tomography (CT) scan. Due to the high possibility of this mass identification as a neoplasm, the patient underwent a laparoscopic right hemicolectomy with an extracorporeal side-to-side isoperistaltic anastomosis. However, the postoperative histological diagnosis of the mass was cecal endometriosis, as the histopathology report noted endometrial tissues in the submucosa and muscolaris propria of the ileocecal region. Endometriosis of the cecum is a rare manifestation and can often be misdiagnosed as a malignant tumor. Further research is required, concerning preoperative characteristics of bowel masses in women, in order to provide optimal operative treatment and avoid unnecessary invasive procedures.