Ali A. Aijaz, DO, Nariman Hossein-Javaheri, DO, Mayada Ismail, MD University at Buffalo, Buffalo, NY
Introduction: Endometriosis is a condition commonly seen in women of reproductive age, with the presence of endometrial glands outside the uterus. A benign condition, it affects approximately 2% to 10% of all women. The most frequent sites are the pelvic peritoneum, ovaries, and uterosacral ligaments. The incidence of intestinal endometriosis is estimated to be from 3% to 37%, with the majority of those reported in the literature involving the serosa or subserosa. We present a unique case of an asymptomatic patient undergoing a screening colonoscopy revealing sigmoid colon endometriosis, involving solely the mucosa.
Case Description/Methods: A 52 year old female with no significant past medical history presented for a screening colonoscopy. She had no family history of colon cancer or any personal history of hematochezia, melena, change in bowel habits, or any other complaints. Colonoscopy revealed a diminutive polyp found in the transverse colon that was removed with jumbo cold forceps, one 12mm polyp in the sigmoid colon (Figure) removed with a hot snare that was resected and retrieved, with a clip placed. Biopsy of sigmoid colon polyp was significant for unremarkable colonic mucosa with increased fibroconnective tissue, benign endometrial glands and stroma, with stains strongly positive with ER and focally positive with PAX-8 IHC stains in the sub-epithelial tissue, consistent with endometriosis. The patient was referred to gynecology for further management and follow-up is pending.
Discussion: Although the frequency of endometriosis in women is quite high, particularly those of childbearing age, it is rare for it to present in the colon. While sigmoid colon endometriosis has been reported in the literature, very few have described solely mucosal involvement of the lesion. Our case adds to the literature regarding this unique manifestation of endometriosis, particularly in an asymptomatic patient undergoing a screening colonoscopy. Clinician awareness of this presentation is important as accurate diagnosis of these lesions as endometriosis changes management and will likely require multidisciplinary involvement.
Figure: Figure 1: 12mm sigmoid colon polyp as seen on colonoscopy.
Disclosures:
Ali Aijaz indicated no relevant financial relationships.
Nariman Hossein-Javaheri indicated no relevant financial relationships.
Mayada Ismail indicated no relevant financial relationships.
Ali A. Aijaz, DO, Nariman Hossein-Javaheri, DO, Mayada Ismail, MD. P3810 - Asymptomatic Sigmoid Colon Endometriosis With Exclusive Mucosal Involvement Detected on Screening Colonoscopy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
