LETTERS TO THE EDITOR Rectal endometriosis and prolactinoma

Sir, With reference to the article by Novella-Maestre et al. (2009) on the experimental treatment of endometriosis with cabergoline (Cb2), the authors suggested that Cb2 manifests its anti-angiogenic effect by acting via VEGFR-2. A case which we recently encountered seems to support this hypothesis. A 36-year-old woman presented in September 2008 with complaints of abdominal, lower back and pelvic pain of 5 months’ duration, as well as recent onset of bleeding per rectum. Irregular, edematous and fragile mucosa, between 14 and 17 cm, was reported on colonoscopic evaluation, and biopsy specimens were obtained with a preliminary diagnosis of colorectal cancer. However, histopathological examination of the obtained specimens did not reveal any signs of malignancy, just non-specific colitis. She was started on a 2-week course of metronidazole and ciprofloxacin. A repeat rectoscopy in November was normal. Two months later, symptoms of inguinal pain and rectal bleeding recurred, and rectosigmoidoscopy performed in April 2009 revealed an irregular, lobulated and fragile mass-like appearance in the rectum (between 10 and 15 cm), occluding nearly half of the lumen. Findings observed on histopathological examination were consistent with a solitary rectal ulcer. A subsequent abdominal MRI scan revealed thickening of the rectosigmoid wall to 1-cm with a 3-cm thick-walled cyst in the right ovary. The patient eventually underwent a total of 10 rectosigmoidoscopy procedures during a 1-year follow-up period up to October 2009. The most recent evaluation showed an irregular appearance in the rectum, at 15 cm, partially occluding the lumen. Biopsy specimens only revealed edematous colon mucosa. The patient was finally referred for surgery and low anterior resection was performed in December. The surgically resected specimen consisted of a rectal segment of 12 cm in length. At 4.5 cm from the distal edge of the specimen intramural endometriosis 4 × 4 × 0.8 cm in size, invading the submucosa, muscular layer and pericolic fat was observed. The lesion also had a 1-cm luminal protrusion. Three of the 11 dissected lymph nodes had endometrial glands.