Colonic metastasis from cervical carcinoma diagnosed by ligation-assisted endoscopic full-thickness resection

Endoscopic ultrasonography (EUS) plays a crucial role in characterizing subepithelial lesions (SELs) and enabling definitive pathological diagnosis through EUS-guided fine-needle aspiration/biopsy [1] [2] [3]. Some experts advocate surveillance with EUS for SELs originating from the muscularis propria that are less than 2 cm in diameter [4]. Here, we present a case of colonic metastasis from cervical carcinoma that was successfully diagnosed using ligation-assisted endoscopic full-thickness resection (EFTR) ([Video 1]).

A colonic metastasis from cervical carcinoma was successfully diagnosed using ligation-assisted endoscopic full-thickness resection.Video 1

A 65-year-old woman with a history of cervical adenocarcinoma, treated surgically 15 months previously, presented with a SEL in the sigmoid colon during colonoscopy ([Fig. 1]). Miniprobe examination demonstrated a 6 × 4-mm hypoechoic mass originating from the muscularis propria ([Fig. 2]). Abdominal computed tomography showed no evidence of metastases.

Fig. 1 Endoscopic image showing a subepithelial lesion in the sigmoid colon that was detected during colonoscopy.

Fig. 2 Endoscopic ultrasonography image using a miniprobe showing a 6 × 4-mm hypoechoic mass originating from the muscularis propria.

Given the small size of the lesion and the technical challenges associated with direct endoscopic resection, ligation-assisted EFTR was performed. Firstly, the lesion was marked using a snare. The lesion was then completely suctioned into the ligation device and a rubber band was released. After the mucosa had been incised using a snare to expose the lesion, en bloc full-thickness resection was achieved by snare excision under the rubber band ([Fig. 3] a). Subsequently, the colonic wall defect was closed using metal clips ([Fig. 3] b).

Fig. 3 Endoscopic images showing: a en bloc full-thickness resection with snare excision under the rubber band after the mucosa had been incised to expose the lesion; b the colonic wall defect closed with metal clips.

Histopathological examination revealed adenocarcinoma characterized by irregular tubular structures with infiltrative growth patterns ([Fig. 4]). Immunohistochemical staining revealed the following profiles: Ki-67 (20%+), P16 (+), PAX8 (focal weak +), SATB2 (−), CK7 (+), and CK20 (−). Based on the morphological features, immunohistochemical profile, and clinical history, the diagnosis was colonic metastasis from cervical carcinoma.

Fig. 4 Histopathological image showing adenocarcinoma that is characterized by irregular tubular structures with infiltrative growth patterns.

Our clinical experience suggests that even small lesions carry a potential risk of malignant transformation. It is imperative to achieve en bloc resection while obtaining pathological diagnosis through a safe, effective, and minimally invasive method, particularly for patients with previous malignancy.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Deprez PH, Moons LMG, OʼToole D. et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 412-429
• 2 Qin X, Ran T, Zhang B. et al. An unusual case of duodenal neuroendocrine tumor presenting with melena diagnosed by EUS-guided fine-needle biopsy. Endosc Ultrasound 2024; 13: 190-192
• 3 Wang S, Cheng G, Hu D. A rare but interesting case of small intestinal tumor diagnosed by transrectal EUS-FNA (with video). Endosc Ultrasound 2024; 13: 269-270
• 4 Sharzehi K, Sethi A, Savides T. AGA Clinical Practice Update on management of subepithelial lesions encountered during routine endoscopy: Expert Review. Clin Gastroenterol Hepatol 2022; 20: 2435-2443.e4

Publication History

Article published online:
04 September 2025