Endomyometriosis of the Rectum With Disseminated Peritoneal Leiomyomatosis 8 Years After Laparoscopic Myomectomy: A Case Report

Giorgio La Greca,Lorenzo Memeo,Cecilia Gozzo,Paolo Di Mattia,Cristina Colarossi,Eliana Piombino,Marco De Zuanni

doi:10.3389/fsurg.2021.666147

Abstract

Endomyometriosis is a rare finding and it can be challenging to diagnose and to treat. It can arise in the uterus, in the ovary, in the broad ligament, in the peritoneal surface and in other pelvic structures. Usually patients with endomyometriosis are asymptomatic, but symptoms could occur due to large dimensions or site of the mass. We present a case of a 49-year-old woman with a symptomatic pelvic mass in the rectal wall, with no history of endometriosis, who underwent laparoscopic myomectomy 8 years earlier.

Highlights

Endomyometriosis is a benign and relatively rare disease first reported by Cozzutto et al in the ovary in 1981 [1]
We report a case of a 49-year-old woman with a symptomatic pelvic mass in the rectal wall, with no history of endometriosis, who underwent laparoscopic myomectomy 8 years earlier
It has been proposed that sub-mesothelial multipotential stem cells can differentiate in smooth muscle cells, endometrial glands and stroma

Summary

INTRODUCTION

Endomyometriosis is a benign and relatively rare disease first reported by Cozzutto et al in the ovary in 1981 [1]. A 49-year-old nulliparous patient with history of hypertension and chronic otitis media came to our attention complaining 3 months of pelvic pain She had undergone a laparoscopic myomectomy 8 years earlier. It showed normal uterus and ovaries and the presence of a trilobed mass adherent to the anterior wall of the rectum and two 2 cm nodules in the omentum and in FIGURE 3 | Pathological findings: (A) H&E staining of the mass, showing a thick smooth muscle layer lined by endometrial epithelium and stroma (10x); (B) immunohistochemical analysis of CD10 showing a diffuse expression in the endometrial stroma without staining of the endometrial mucosa (20x); (C) PAX8 nuclear expression limited to the endometrial mucosa (40x); (D) smooth muscle actin (SMA) expression in the smooth muscle layer (10x). A digital rectal examination and a CT scan of abdomen and pelvis, performed 6 months from surgery, have excluded a local recurrence and so far, almost 1 year post surgery, the patient doesn’t refer symptoms

DISCUSSION

ETHICS STATEMENT