Dados do Trabalho

Título

Underwater Mucosectomy to Treat Colon Mesenchymal Leiomyoma Lesion - a Rare Case Report

Resumo

Case presentation: 60 year-old female without any gastrointestinal symptoms, illness or surgery, underwent a screening colonoscopy. The physical examination was normal and the per-rectal examination did not reveal any mass or blood. A colonoscopy revealed a subpediculated polypoid lesion in the rectosigmoid transition, measuring 10 mm, smooth and well delimited. It was successfully removed by underwater endoscopic mucosal resection, followed by the application of 2 endoscopic clips. Anatomopathological evaluation revealed a hypocellular, eosinophilic lesion with elongated to oval nuclei and loose chromatin, without atypia. It was diagnosed as a submucous leiomyoma. The patient was followed up for 1 year, remained asymptomatic and without complaints. Discussion: Colonic leiomyomas are rare smooth muscle tumors that represent the largest group of primary gastrointestinal non-epithelial neoplasms and have an increase in frequency in individuals over 60 years-old. They are frequently asymptomatic, often discovered on routine endoscopic evaluations and majorly bening. Histological appearance, site, tumor size and mitotic count are considered to predict the malignant potential of these tumors. Although they appear predominantly as sessile lesions, the subpedicled and pedunculated lesions are also possible, but rare. Our case describes a subpedicled polypoid lesion in the rectosigmoid transition, diagnosed as submucous leiomyoma. Usually, colonic leiomyomas can be treated by endoscopic resection, which uses the submucosal injection technique to lift the lesions and avoid the risk of perforation. The resection is recommended in plenty of situations, but is contraindicated when the tumor doesn’t lift with the submucosal injection. This case was resected by underwater endoscopic mucosectomy, a procedure that realizes complete immersion of the lesion and underwater diathermic loop resection, which allows the observation of the mucosa and submucosa floating while the muscle layer remains distended. Normally, the submucosal injection is used, but there are studies realized and published without the use of it, like this one. Final comments: colonic leiomyomas can be responsible for gastrointestinal symptoms and a differential diagnosis for pre-cancerous epithelial lesions. Therefore, the resection is essential and can be performed by different techniques. In this case, the chosen technique was underwater mucosectomy, likely the first successfully resected case.

Área

Endoscopia - Colonoscopia