A64-year-oldwomanpresentedwithabdominalpainandvomiting.CTandcolonoscopyrevealeda tumorousstrictureintheupperrectum.Frompathologicalfindingsofabiopsiedspecimen,wediagnosed thecaseasadenocarcinomaprobablyarisenfromthegynecologicalorganratherthanfromtheintestine. She had undergone total hysterectomy and right oophorectomy for endometriosis at the age of 39. We performedlaparoscopiclowanteriorresectionofrectum,D3lymphnodedissection,andassociatedleftoophorectomy.Theintraoperativefrozensectiondiagnosiswasendometroidadenocarcinomaoftherectum. Anoduleonthehepaticsurfacewhichwasdetectedandresectedduringthesurgerywasdiagnosedas metastasis of adenocarcinoma. A lot of lymph nodes were metastasis positive. After the surgery, six coursesofadjuvantchemotherapywithpaclitaxel,carboplatin,andbevacizumabwereconducted.Shede-velopedlymphnodeandlivermetastasesoneyearand3monthsaftertheoperation,sothatchemotherapywasresumed.Asmalignanttransformationfromrectalendometriosisisrare,wepresentthiscasetogetherwithsomebibliographicalcomments.