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From question on page 1402
Figure 2 shows columnar epithelium (arrow) which is of the non-mucin secreting type, and in fig 3 the surrounding stroma is positive for CD10 (positivity being reflected by the areas of brown staining) consistent with the diagnosis of colonic endometriosis. CD10, a human membrane associated neutral endopeptidase, is widely used in lymphoma phenotyping but it also stains normal, ectopic, and neoplastic endometrial stromal cells. Hence it is used as an adjunctive diagnostic tool in difficult cases of endometriosis.
Endometriosis is a common condition affecting 8–15% of menstruating women. Colonic involvement is seen in 15–37% of patients with pelvic endometriosis. Meyer described the first case of colonic endometriosis in 1909 and Bashist et al reported the first colonic endometriosis confirmed on endoscopic biopsy in 1983.
The intestinal tract is the most common site for extra-genital endometriosis. Other sites include the urinary tract, surgical scars, skin, umbilicus, lung, diaphragm, liver, and pancreas. The rectosigmoid area is the most affected part of the intestinal tract followed by the small intestine, caecum, and appendix. Although most of the patients can be asymptomatic, they can present with cyclical haematochezia, altered bowel habit, abdominal pain, intestinal obstruction, and abdominal mass. As most endometrial deposits are in the serosa, muscularis propria, and submucosa, colonoscopy can be negative. Due to the localising and stricturing nature, it can mimic Crohn’s disease and malignancy creating a diagnostic difficulty. Ultrasound and magnetic resonance imaging are useful in diagnosing endometriosis depending on its size and location. Laparoscopy is the preferred investigation as it allows complete evaluation of both intestinal and genital tracts.
Treatment depends on the patient’s age, desire for pregnancy, and severity of the condition. Medical therapy with hormonal manipulation to inhibit endometrial growth is usually ineffective in colonic disease. Surgical options are laser therapy for serosal implants and laparoscopic or open resection of the affected bowel segment with or without removal of the uterus and ovaries.
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