This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. This is a 32 year old woman with a long history of rectal pain who in the last few months had developed rectal bleeding associated with her menstrual periods and she underwent colonoscopy at an outside center where that mucosally based lesion was seen in the rectum. Examining this at our center, you can see that proximal to the mucosally based area there was a substantial submucosal press or extrinsic press on the colon. Then here's the mucosally based part of the lesion. Biopsies taken at the outside hospital were non-diagnostic. We're going to look at the mucosally based part of the lesion now with NBI and then a little bit more in white light. But when we look at the pit pattern of the lesion using NBI and the close focus, there is not an obvious neoplastic pattern to the surface of the mucosal part of this lesion. This is a colonic endometrioma. Biopsies at our center were diagnostic. I think the clues here, of course, are the history of rectal bleeding with menstrual periods, but also in this case, the component right there that's either submucosal or extrinsic that's proximal to the mass lesion. And then I think finally, the lack of a neoplastic type pit pattern on the surface of the mucosally based part. This is a rare lesion of course, but everything fit well enough. And with our biopsies being diagnostic, I did not remove any portion of this, including this mucosally based part, but rather refer the patient to gynecology for management.

32-year-old woman

rectal pain

rectal bleeding

colonoscopy

colonic endometrioma