This case report describes a rare case of a patient with both hemorrhoids and endometriosis in the rectum. A 37-year-old female presented with a 3-year history of bloody stools and was initially diagnosed with hemorrhoids. During a digital rectal exam, a small 0.8 cm x 0.6 cm mass was also detected in the rectal wall. Imaging and biopsy confirmed the mass was endometriosis located in the muscularis and submucosa of the rectum. The presence of the more common hemorrhoids likely led to an initial missed diagnosis of the rare endometriosis. This case highlights the importance of thorough physical exams to avoid diagnostic pitfalls when multiple
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
Side of simple renal cysts usually solitary , but also showed a small but multiple or atrial rarely occurs in bilateral , compared with polycystic kidney disease, the clinical manifestations and pathological manifestations are different.
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
Side of simple renal cysts usually solitary , but also showed a small but multiple or atrial rarely occurs in bilateral , compared with polycystic kidney disease, the clinical manifestations and pathological manifestations are different.
Vesicouterine Fistula Following Cesarean Delivery – Ultrasound Diagnosis and ...Michelle Fynes
Vesicouterine fistulae are uncommon, with most units reporting 1–5 cases over 5–15 year periods. To date there has been a paucity of case reports regarding this problem and only a few case series. In this report we outline the presentation and management of a vesicouterine fistula complicating a repeat Cesarean delivery, specifically describing the role of transvaginal ultrasound.
Tumors of the appendix are rare. They pose both a diagnostic and therapeutic dilemma to the surgeon. The paper discusses the various intricacies of these lesions.
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
Imaging orchitis epidydmitis epidydmo orchitis
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound TRANSRECTAL ULTRASOUND images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
Imaging prostatitis ,urethritis Dr Ahmed EsawyAHMED ESAWY
Imaging prostatitis ,urethritis dr ahmed esawy
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound TRANSRECTAL ULTRASOUND images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
Abdominal Wall Endometrioma: A Diagnostic Enigma—A Case Report and Review of ...KETAN VAGHOLKAR
Background. Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the
gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.
Introduction. Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving
rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an
incidence of less than 2% following gynaecologic operations. Case Report. A case of abdominal wall endometrioma diagnosed
clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of
this condition. Discussion. The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion.
Clinical evaluation confirmed by supportive imaging is diagnostic.Wide local excision is the mainstay of treatment.
Three major theories are commonly cited.
Direct implantation of endometrial cells(Sampson Theory), typically by means of retrograde menstruation:
This mechanism is consistent with pelvic endometriosis and its predilection for the ovaries and pelvic peritoneum, abdominal incision or episiotomy scar.
It is probable that more than one theory is necessary to explain the diverse nature and locations of endometriosis.
Underlying all these possibilities is a yet undiscovered immunologic factor
Vesicouterine Fistula Following Cesarean Delivery – Ultrasound Diagnosis and ...Michelle Fynes
Vesicouterine fistulae are uncommon, with most units reporting 1–5 cases over 5–15 year periods. To date there has been a paucity of case reports regarding this problem and only a few case series. In this report we outline the presentation and management of a vesicouterine fistula complicating a repeat Cesarean delivery, specifically describing the role of transvaginal ultrasound.
Tumors of the appendix are rare. They pose both a diagnostic and therapeutic dilemma to the surgeon. The paper discusses the various intricacies of these lesions.
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
Imaging orchitis epidydmitis epidydmo orchitis
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound TRANSRECTAL ULTRASOUND images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
Imaging prostatitis ,urethritis Dr Ahmed EsawyAHMED ESAWY
Imaging prostatitis ,urethritis dr ahmed esawy
IMAGING OF LOWER URINARY TRACT INFECTION LUTI
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray ultrasound TRANSRECTAL ULTRASOUND images
Cystitis
Prostatitis
urethritis
Orchitis
Epidydmitis
Epidydmo-orchitis
funiculitis
Vastitis/differentitis
Seminal vesiculitis
Abdominal Wall Endometrioma: A Diagnostic Enigma—A Case Report and Review of ...KETAN VAGHOLKAR
Background. Abdominal wall endometriomas are quite uncommon. They are usually misdiagnosed by both the surgeon and the
gynaecologist. Awareness of the details of this rare condition is therefore essential for prompt diagnosis and adequate treatment.
Introduction. Endometriosis though a condition commonly seen in the pelvic region can also occur at extrapelvic sites giving
rise to a diagnostic dilemma. Abdominal wall endometrioma is one such complex variant of extrapelvic endometriosis with an
incidence of less than 2% following gynaecologic operations. Case Report. A case of abdominal wall endometrioma diagnosed
clinically and treated by wide surgical resection is presented to highlight the importance of clinical evaluation in the diagnosis of
this condition. Discussion. The etiopathogenesis, presentation, investigations, and management are discussed briefly. Conclusion.
Clinical evaluation confirmed by supportive imaging is diagnostic.Wide local excision is the mainstay of treatment.
Three major theories are commonly cited.
Direct implantation of endometrial cells(Sampson Theory), typically by means of retrograde menstruation:
This mechanism is consistent with pelvic endometriosis and its predilection for the ovaries and pelvic peritoneum, abdominal incision or episiotomy scar.
It is probable that more than one theory is necessary to explain the diverse nature and locations of endometriosis.
Underlying all these possibilities is a yet undiscovered immunologic factor
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
Duodenal Intussusception Secondary to Hamartomatous Polyps of the Duodenum an...semualkaira
Hamartomas of the duodenum are benign duodenal tumors comprising approximately 5-10% of duodenal tumors. The incidence is <0.01%. Typically asymptomatic, they may
manifest as intestinal obstruction, gastrointestinal hemorrhage,
biliary obstruction or intussusception. Intussusception as a manifestation of duodenal hamartoma is rare in itself with less than 200
cases reported in the literature
Duodenal Intussusception Secondary to Hamartomatous Polyps of the Duodenum an...semualkaira
Hamartomas of the duodenum are benign duodenal tumors comprising approximately 5-10% of duodenal tumors. The incidence is <0.01%. Typically asymptomatic, they may
manifest as intestinal obstruction, gastrointestinal hemorrhage,
biliary obstruction or intussusception. Intussusception as a manifestation of duodenal hamartoma is rare in itself with less than 200
cases reported in the literature.
Duodenal Intussusception Secondary to Hamartomatous Polyps of the Duodenum an...semualkaira
Hamartomas of the duodenum are benign duodenal tumors comprising approximately 5-10% of duodenal tumors. The incidence is <0.01%. Typically asymptomatic, they may
manifest as intestinal obstruction, gastrointestinal hemorrhage,
biliary obstruction or intussusception. Intussusception as a manifestation of duodenal hamartoma is rare in itself with less than 200
cases reported in the literature
Cesarean scar endometriosis: Clinical presentation and imaging features with a focus on MRI.
Endometriose der Bauchwand nach Kaiserschnitt [Presentation in English].
The esophageal duplication cyst is a congenital defect of the digestive tract. It has an estimated prevalence of 0.012%, with higher predominance in males. Although it is a common fi nding in children, diagnosis of an esophageal duplication in adults is rare. Following ileal duplication, esophageal is the second most common duplication of the gastrointestinal tract, representing the 10-15% of all gastrointestinal duplication defects. For esophageal duplication, there are two main variants: cystic and tubular, the latter being the least common. They are usually developed during the third to fifth week of gestation due to failure of the vacuolar coalescence. Duplication cysts are commonly located in the distal third of the esophagus.Treatment should always be surgical, even at the asymptomatic stage
of disease, given the possibility of symptom development and complication appearance. Here we present a case of an adult patient presenting with an esophageal duplication cyst with a brief literature review.
Neuroendocrine Tumour in Meckel’s Diverticulum as a Cause of Acute Abdomensemualkaira
Meckel’s diverticulum is the most common congenital defect of the gastrointestinal tract, caused by an incomplete obliteration of ductus omphaloentericus (yolk sac) during intrauterine life. Given that the ductus omphaloentericus contains pluripotent cells during the intrauterine life, the diverticular mucosa may contain cell islets of different types of tissues, such as gastric and intestinal mucosa, pancreatic cells and others. However, the occurrence of neuroendocrine tumours in Meckel’s diverticulum is very rare. Causes ileus, besides its tumorous tissue, are fibrous changes in mesentery induced by the neuroendocrine tumour as well.
The paper presents a case of a 48-year-old patient with an acute abdomen, caused by perforation of Meckel’s diverticulum. Histological examination has revealed the presence of a neuroendocrine tumour spreading across muscularis propria and incipient spread into subserosa.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. patient was diagnosed with hemorrhoids. During the
digital rectal examination, a mass of approximately
1.5 cm × 1.5 cm under the rectum mucosa 8 cm from
the anus was also detected.
Materials and methods
The tissue samples were examined by hematoxylin-eosin
(HE) and immunohistochemistry staining as described
previously [7]. The primary antibodies included actin
(sm) (1:100, DAKO), CD10 (1:100, DAKO), CK (1:200,
DAKO), Ki67 (1:100, DAKO) and ER (1:200, DAKO).
Primary antibodies were omitted as a negative control.
This study was approved by the institutional Ethics
Committees of China Medical University and conducted
in accordance with the ethical guidelines of the Declar-
ation of Helsinki.
Results
Imaging and gross features
Abdomen computed tomography (CT) examination de-
tected a mass in the wall of the rectum (Fig. 1). The
nodule was approximately 9 mm and dimly visible. It
was located in the lower part of the left wall of the rec-
tum. No abnormity was detected in the walls of other
gastrointestinal ducts. No retroperitoneal enlarged
lymph node was found. On gross examination, the
resected rectal wall was approximately 3 cm long, and
the thickness was 0.9 cm. A mass of approximately
0.8 cm × 0.6 cm was found in the muscularis and sub-
mucosa of the rectum. The margin of the mass was not
clear. The cut face was gray-white with scattered red
hemorrhage.
Microscopic features
The histopathological findings are shown in Fig. 2. The
ectopic endometrial tissues were detected in the muscu-
laris (A) and submucosa (B) of the rectum. The ectopic
tissues included endometrial glands and surrounding
interstitial tissue (C, D). The epithelial cells were colum-
nar with no marked atypia and formed a monolayer (D).
Dilated small vessels were also detected in the muscu-
laris (E) and submucosa (F) of the rectum.
Immunophenotype
Immunostaining findings are shown in Fig. 3. Actin (sm)
expression was observed in smooth muscle cells in the
muscularis of the rectum. The submucosa of the rectum
and the endometrial interstitium were negative for actin
(sm). These actin (sm) staining findings can also confirm
that the ectopic endometrial tissues were located in the
muscularis and submucosa of the rectum. Positive CD10
staining confirmed the endometrial interstitium. CK and
ER staining were found in the epithelial cells of the
endometrium. A hot-spot was selected and 500 cells
were counted and examined to calculate the Ki67 index.
The Ki67 index in the ectopic endometrial tissues was
approximately 5%.
Discussion
Endometriosis occurring in the digestive tract mostly
involves the rectum and sigmoid colon [1]. The peak age
incidence is from 30 years old to before menopause [1].
Endometriosis of the large intestine is usually a compo-
nent of pelvic endometriosis and secondary to the
endometriosis of the rectovaginal septum [1]. Ectopic
endometrial tissues in the rectum are typically located in
the muscularis and rarely in the submucosa. The mucosa
of the rectum is usually not involved [1]. In the current
case, ectopic endometrial tissues were located in both
the muscularis and submucosa of the rectum. Falleni re-
ported a rare case of transmural endometriosis in the
rectum, which was combined with primary adenocarcin-
oma [8]. In fast frozen section examination, endometri-
osis in the rectum may be mistaken for cancer for the
glands seen in the muscularis of the rectum, which may
be mistaken as cancer cell invasion. Adenocarcinoma
can arise from endometriosis, including in the rectum
[9]. The most common pathological type is endome-
trioid adenocarcinoma. Yu reported a rare case of clear
cell adenocarcinoma arising from ectopic endometrial
Fig. 1 Imaging of the rectum. A dimly visible small nodule of
approximately 9 mm (indicated by the arrow) was detected in
the lower part of the left wall of the rectum. The walls of other
gastrointestinal ducts were not markedly thickened. No obvious
stenosis or expansion was found. No retroperitoneal enlarged
lymph node was found
Shi and Fan BMC Women's Health (2018) 18:120 Page 2 of 5
3. tissues in the rectum [9]. In the current case, the epithe-
lial cells of the ectopic endometrial glands had no
marked atypia and no malignant transformation were
detected based on the microscopic histopathological
findings.
Hematochezia is a common symptom in hemorrhoids and
can also occur in endometriosis of the rectum [1, 10, 11].
The patient in the current case had the symptom of hemato-
chezia for 3 years. The patient had prolapsus of the anus and
rectum, which was easily detected by digital rectal examin-
ation. However, the endometriosis of the rectum was easily
missed, as the lesion was under the mucosa of the rectum,
and the site was quite far from the anus. In this case, the
nodule of the endometriosis was quite small and difficult to
detect. As the symptoms of hematochezia were fully consist-
ent with hemorrhoids, a doctor might have overlooked the
examination of the other parts of the rectum. Thus, the exist-
ence of hemorrhoids in the current case may represent a
diagnostic pitfall for endometriosis. Stenosis of the intestine
and rectal pain are common symptoms of endometriosis in
the rectum [1]. Endometriosis in the rectum may be mis-
taken for cancer because of obstruction of the bowel canal
revealed by colonoscopy and radiological examinations [3,
12]. It is worth noting that patients with endometriosis are
relatively younger than those with intestine carcinoma. These
symptoms were not observed in this case, which may be due
to the relatively small size of the lesion. Because the specific
symptoms of endometriosis in the rectum were not obvious
in the current case, it was more easily missed, especially as it
was combined with hemorrhoids. In summary, the reasons
for diagnostic pitfalls for endometriosis in the rectum include
(1) endometriosis combined with hemorrhoids. The patient
Fig. 2 Histopathological findings. The ectopic endometrial tissues (black arrows) were mainly located in the muscularis (a) and submucosa (b) of
the rectum. The ectopic endometrial glands (black arrow) and surrounding interstitial tissue (white arrow) at high magnification (c, d). The
epithelial cells were columnar with no marked atypia (black arrow) (D). Dilated small vessels (black arrows) were also detected in the muscularis
(e) and submucosa (f) of the rectum. Scale bar: A, B: 40 μm; C, E, F: 20 μm; D: 10 μm
Shi and Fan BMC Women's Health (2018) 18:120 Page 3 of 5
4. had a 3-year history of hemorrhoids, and her symptoms were
fully consistent with the diagnosis of hemorrhoids. (2) The
nodule of the endometriosis in the rectum was small and not
easy to detect. (3) Under the microscope, there was small
vessel dilatation in the bowel with endometriosis, which
could lead to a consideration of hemorrhoids unless exten-
sive samples were taken. In summary, obvious symptoms
can sometimes be misleading.
Conclusion
Endometriosis of the rectum is relatively rare com-
pared to hemorrhoids. When these diseases coexist,
the rare disease is easily missed, especially when the
common one causes obvious symptoms but the rare
one does not. Another reason for the diagnostic chal-
lenge is that these diseases have some similarities in
histopathological findings.
Fig. 3 Immunostaining findings. Actin (sm) was positive in the smooth muscle cells (black arrow) in the muscularis of the rectum and
negative in the submucosa (gray arrow) of the rectum and the endometrial interstitium (the white arrow). CD10 was positive in the
endometrial interstitium (black arrow). CK and ER were positive in the epithelial cells of the endometrium (black arrows). The Ki67 index
in the ectopic endometrial tissues was approximately 5% (black arrow). Negative control shows a representative negative control for CK
immunostaining obtained by the omission of the primary antibody. Scale bar: actin (sm) (left), CK, CD10, ER, negative control: 20 μm;
actin (sm) (right), Ki67: 40 μm
Shi and Fan BMC Women's Health (2018) 18:120 Page 4 of 5
5. Abbreviations
CT: Computed Tomography; HE: Hematoxylin-eosin
Funding
This work was supported by the National Natural Science Foundation of
China (no.81472599 to Chuifeng Fan, MD).
Availability of data and materials
All data generated or analyzed during this study are included in this
published article.
Authors’ contributions
XY S and CF F designed the study. XY S performed the histopathological
evaluation and the literature review. XY S drafted the manuscript. XY S and
CF F evaluated the immunohistochemical stains. CF F revised the
manuscript. Both authors read and approved the final manuscript.
Ethics approval and consent to participate
The institutional Ethics Committees of China Medical University approved the study.
Consent for publication
Written informed consent was obtained from the patient for publication of
this case report and accompanying images.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Received: 27 October 2017 Accepted: 22 June 2018
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