Mucosal changes in the large bowel with endometriosis: A possible cause of misdiagnosis of colitis?

Langlois, Neil E. I.; Park, Kenneth G. M.; Keenan, R. A.

doi:10.1016/0046-8177(94)90061-2

Cited by 88 publications

(25 citation statements)

References 17 publications

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“…Some authors suggested that this mucosa likely represents a preneoplastic alteration, given its unique histologic, histochemical, and ultrastructural features, as well as its identification adjacent to colorectal adenomas and carcinomas and other conditions associated with increased colorectal cancer risk (18,19). Others, however, suggested that transitional mucosa represents a nonspecific secondary change because similar mucosal alterations may be seen adjacent to tumors other than adenocarcinoma (13,14), as well as in mucosa adjacent to a heterogeneous group of colorectal diseases such as mucosal prolapse (20), diverticular disease (21), and endometriosis (22). Sawady et al (16) found the immunohistochemical features of transitional mucosa adjacent to primary colorectal adenocarcinoma and metastases to the colon to be identical, lending further support to the concept that this mucosa represents a nonspecific reactive change.…”

Section: Figurementioning

confidence: 99%

Hyperplastic-Like Mucosal Change in Crohn's Disease: An Unusual Form of Dysplasia?

2000

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Patients with Crohn's disease are at increased risk of developing intestinal adenocarcinoma. Dysplasia is both a marker and a precursor of adenocarcinoma in this setting. In a review of our cases of Crohn's-related adenocarcinoma, we noted a peculiar hyperplastic-like mucosal change (HPC) in mucosa both adjacent to and distant from the adenocarcinoma in some cases. However, the significance of this change is unknown.We evaluated 30 cases of Crohn's-related adenocarcinoma and 30 age-and site-matched resection specimens with Crohn's disease without adenocarcinoma to determine the prevalence of this mucosal alteration in these groups. HPC was recognized by a diffuse expanse of flat mucosa with an architecture resembling that seen in colorectal hyperplastic polyps and composed of cells with cytologically bland basal nuclei and apical cytoplasmic mucin distention. The relationship of the HPC to the adenocarcinoma was noted in the Crohn's-related adenocarcinoma cases. An immunohistochemical stain for p53 (antibody DO7) was performed on all cases with HPC in both groups.HPC was identified in 10 of 30 (33%) cases of Crohn's-related adenocarcinoma compared with 3 of 30 (10%) cases in the control group (P ‫؍‬ .03). In the 10 cases of Crohn's-related adenocarcinoma with HPC, this alteration was found adjacent to the adenocarcinoma in 3 cases, distant to the adenocarcinoma in 5 cases, and both adjacent to and distal from the adenocarcinoma in 2 cases. In two specimens, HPC was seen immediately adjacent to adenocarcinoma in the absence of adjacent dysplasia. p53 immunoreactivity was noted in HPC in 5 of 10 (50%) Crohn's-related adenocarcinomas. In contrast, p53 immunoreactivity was not seen in HPC in the three control cases with this mucosal alteration.In conclusion, HPC is found significantly more commonly in mucosa both adjacent to and distant from Crohn's-related adenocarcinoma when compared with age-and site-matched controls. In addition, p53 immunoreactivity is more commonly seen in HPC in cases of Crohn's-related adenocarcinoma compared with controls. These data suggest that this mucosal alteration may, in some cases, represent an unusual form of dysplasia in this setting.

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Section: Figurementioning

confidence: 99%

Hyperplastic-Like Mucosal Change in Crohn's Disease: An Unusual Form of Dysplasia?

2000

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“…In patient 5, histology of the mucosal biopsy showed features suggestive of colitis but not entirely specific for chronic inflammatory bowel disease. These secondary changes in the colorectal mucosa can mimic aspects of other diseases, especially inflammatory bowel diseases, ischemic colitis and even malignancies which may cause considerable diagnostic confusion [10,11,12]. …”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome and Long-Term Follow-Up after Segmental Colorectal Resection in Women with a Complete Obstruction of the Rectosigmoid due to Endometriosis

Jong¹,

Mijatovic²,

Waesberghe

et al. 2009

Dig Surg

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Introduction: Intestinal involvement is reported in up to 12% of women with endometriosis. Complete large bowel obstruction is a rare complication of intestinal endometriosis. It is estimated to occur in less than 1% of the cases. Objective: The aim of this study is to evaluate the surgical outcome and long-term follow-up after segmental colorectal resection in women with a complete obstruction of the rectosigmoid due to endometriosis. In addition, the diagnostic work-up is described and discussed in view of the current literature. Patients and Methods: We present a case series of 5 patients with a complete obstruction of the rectosigmoid due to endometriosis who were finally treated in our hospital within a multidisciplinary endometriosis team. We retrospectively analyzed all patients with this condition who were referred in the period January 2000 to December 2006. Results: All patients (mean age 31.8 years, range 25–43 years) underwent emergency surgery resulting in a diverting colostomy before referral to our hospital. The principal diagnostic tool used was magnetic resonance imaging which demonstrated in all patients multiorgan endometriosis with complete obstruction of the rectosigmoid. Thereafter, all patients underwent a segmental colorectal resection by re-laparotomy. The diagnosis intestinal endometriosis was histologically confirmed in all cases. After surgery no major complications occurred. During a follow-up of 18–36 months, residual symptoms such as chronic constipation, deep dyspareunia and chronic pelvic pain were reported in 2 patients. No recurrences of intestinal endometriosis occurred. Conclusion: In our case series, segmental colorectal resection showed a favorable surgical outcome with no major complications. In the long-term follow-up, a limited number of residual symptoms were reported and no recurrences occurred. Intestinal endometriosis as a cause of bowel obstruction is often a diagnostic challenge mimicking a broad spectrum of diseases. It should be included in the differential diagnosis in women of reproductive age presenting with any symptoms of bowel obstruction. Magnetic resonance imaging is recommended as the primary imaging technique in such cases. In our opinion, these patients should be treated in a multidisciplinary setting.

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“…17,18 The resulting fibrosis and stricture formation may be the reason behind most intestinal endometriosis lacking the classical cyclical abdominal pain during menstrual cycle.…”

Section: 13mentioning

confidence: 99%

Small bowel obstruction due to subserosal endometriosis: an elusive condition

Mishra

Vats

Pandey

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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Mucosal changes in the large bowel with endometriosis: A possible cause of misdiagnosis of colitis?

Cited by 88 publications

References 17 publications

Hyperplastic-Like Mucosal Change in Crohn's Disease: An Unusual Form of Dysplasia?

Hyperplastic-Like Mucosal Change in Crohn's Disease: An Unusual Form of Dysplasia?

Surgical Outcome and Long-Term Follow-Up after Segmental Colorectal Resection in Women with a Complete Obstruction of the Rectosigmoid due to Endometriosis

Small bowel obstruction due to subserosal endometriosis: an elusive condition

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