F/46

C/C polyp in the sigmoid colon

V/S BP 120/80 mmHg HR 84/min

ROS

melena/hematochezia (-/-) bowel habit change (-) bearing down sensation

PMHx.

hemorrhoidectomy, 14 YA

Digital rectal examination: normal

CA 125 : normal

Cervicovaginal specimen : normal

CT

submucosal mass lesion at the anterior portion of rectum

lymphadenopathy, 1.2 x 0.5 cm, the left mesentery at the kidney level

no mass lesion in the liver and other solid organs in the abdomen

ascites (-)

lung and bone : within normal limits

Colonoscopy

nodular elevated lesion at AV 12cm 4-5cm sized elevated lesion covering mucosa : normal at the margin hyperemic and nodular mucosa at the center hard in consistency

Impression)

#1. lymphoma #2. invasion of gynecologic malignancy #3. polyp

Submucosal tumor ? Extrinsic compression ?

Differential diagnosis of rectal submucosal tumor

Non-neoplastic lesion Neoplastic lesion

Differential diagnosis of rectal submucosal tumor

Non-neoplastic lesion Neoplastic lesion

Intramural origin Extramural origin

EndometriosisVascular lesionsCystic lesionsHematoma

Endometriosis

Onset : child bearing age Site : Rectosigmoid area (96%), appendix, ileumSymptom : asymptomatic localized tenderness, low back pain intermittent abdominal pain, consipation hematochezia (rare) - usually not related to menstrual cycleDiagnosis : Clinical suspicion – IBS Colonoscopy and biopsy CT : well enhancing mass

Differential diagnosis of rectal submucosal tumor

Non-neoplastic lesion Neoplastic lesion

Intramural origin Extramural origin

LipomaCarcinoid tumorHemangiomaGISTLymphomaOther primary tumors

Metastatic tumorDirect invasion of extracolonic tumor

Lymphoma

Primary lymphoma of intestine Stomach > small intestine > large intestine

Lymphoma of large intestine mostly non-Hodgkin B-cell lymphoma ileocecal area – rectosigmoid region

Symptom : non-specific bleeding, obstruction

Morphologic manifestation : fungating mass, infiltration, ulcer, SMT

Impression

1. Endometriosis 2. Lymphoma