Metastatic Endometrial Cancer to the Sigmoid Colon Masquerading as Primary Colorectal Cancer

Abstract

A 67-year-old female presented with a chief complaint of hematochezia. Medical history was notable for stage 1a endometrial carcinoma status post treatment with radiotherapy alone. The patient was not considered a candidate for surgical intervention at the time due to multiple underlying comorbidities. Colonoscopy revealed a 4 cm, nonobstructive, friable, and ulcerated mass in the sigmoid colon. Initially this was concerning for a primary colorectal carcinoma, although immunohistochemistry revealed a uterine endometrial origin of the lesion. A total hysterectomy was eventually performed along with surgical resection of the affected segment of the colon, which was followed by radiation therapy. This case illustrates an unusual site of metastasis for endometrial carcinoma. The colonic metastasis of endometrial adenocarcinoma is reported to be rare and unusual, especially in the absence of endometriosis. Immunohistochemistry staining is an important adjunct in distinguishing the diagnosis of endometrial adenocarcinoma from primary colorectal carcinomas. Primary colon cancers are cytokeratin-7 negative and cytokeratin-20 positive, whereas endometrial cancers are cytokeratin-7 positive and cytokeratin-20 negative. This case is important given the scarcity and peculiarity of metastatic colon cancer originating from uterine adenocarcinomas. The possibility of metastatic disease should be maintained with identification of solitary colonic lesions, especially when there is a prior history of malignancy.

Metastasis of endometrial adenocarcinoma masquerading as a primary rectal cancer: A rare case report with literature review

“…Recently, 2 rare similar cases of sigmoid colonic metastasis of endometrial adenocarcinoma in the absence of endometriosis was illustrated. [4,8] To date, no case was reported in rectum, especially in the patient with MSI. Therefore, this is the first case report of metastasized endometrial adenocarcinoma occurring in rectum without endometriosis.…”

“…To our knowledge, only 5 similar cases have been published in the literature. [4][5][6][7][8] This is the first case report of endometrial adenocarcinoma with MSI, which metastasis to the rectum in the absence of endometriosis.…”

Malignant Bowel Obstruction Due to Intraluminal Metastasis of Endometrial Adenocarcinoma Located in the Sigmoid Colon After Nine Years of Follow-Up

“…Its incidence is higher in postmenopausal females (70%) and is uncommon in females under 40 years (<5%) [ 1 , 3 ]. Despite this, endometrial adenocarcinoma represents the fourth most common malignant neoplasm in adult females, behind colorectal carcinoma, and the sixth cause of cancer-related death [ 4 ].…”

“…Oncological treatment in its initial stages according to the FIGO classification consists of hysterectomy, bilateral adnexectomy, and pelvic lymphadenectomy. Radiotherapy is also a therapeutic option in these stages with similar survival rates [ 4 ]. Thus, patients with stage I or II (FIGO classification) have 90% and 80% survival, respectively, at five years.…”

“…Subsequently, metastatic involvement after a long latency period was described by Franchello et al in 2015 [ 1 ]. Nowadays, there are three cases of metastasis at the endoluminal rectum and distal sigmoid described [ 2 , 4 , 9 ]. Our case is the first description of an endoluminal metastasis at the sigmoid colon with a stenotic pattern that developed nine years after a stage IA endometrial adenocarcinoma (FIGO classification) undergoing surgery.…”