PMC5832128_01
The nodule was visualized at the hepatic flexure with mild ulceration and bleeding at the surface. Ulceration and blood loss were the presumed explanation for the patient's chronic iron deficiency.
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She underwent an esophagogastroduodenoscopy (EGD) that was of normal result and a colonoscopy that revealed moderately severe diverticulosis and a nodular ulcerated lesion at the hepatic flexure (Figure 1) that was partially removed by hot snare cauterization (Figure 2).
The nodule was partially removed by cold snare polypectomy but was not amenable to complete removal under endoscopy.
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She underwent an esophagogastroduodenoscopy (EGD) that was of normal result and a colonoscopy that revealed moderately severe diverticulosis and a nodular ulcerated lesion at the hepatic flexure (Figure 1) that was partially removed by hot snare cauterization (Figure 2).
(a) Staining of the colonic nodule shows active proliferative endometrial glands and stromal tissue (hematoxylin and eosin, 40x). (b) Immunohistochemistry demonstrates diffusely positive staining for the estrogen receptor in a pattern consistent with endometrial tissue (100x).
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Histological analysis of the biopsies noted mural endometriosis and adenomatous tissue within the endometrial tissue and surrounding mucosa (Figure 3).
Approximately eight months after cold snare polypectomy and treatment with conjugated estrogen/bazedoxifene, no evidence of the nodule remained at the marked site at the hepatic flexure of the colon.
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Follow-up colonoscopy, eight months after the initial colonoscopy and five months of CE/BZA therapy, demonstrated scarring from the initial procedure and no residual nodule at the hepatic flexure (Figure 4).