Endometrioid adenocarcinoma of the rectovaginal septum with invasion of the rectum: a case report and review of literature

Ye, Hua; Gu, Jiaojiao; Qi, Yuanlin; Zhao, Wei; Wang, Xinlu

doi:10.1186/s12957-019-1743-0

Cited by 14 publications

(11 citation statements)

References 29 publications

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“…Endometriosis is defined as DIE when the lesion infiltrates ≥5 mm deep into the peritoneum or invades important organs such as intestine, ureter, and bladder. DIE malignant transformation is often misdiagnosed as rectal cancer or cervical cancer because it is located in the lowest position of pelvic cavity, which is in close proximity to rectum and cervical tissue ( 9 , 10 ). DIE causes endometrial cells to flow back into the pelvic cavity.…”

Section: Discussionmentioning

confidence: 99%

Deep Infiltrating Endometriosis Malignant Invasion of Cervical Wall and Rectal Wall With Lynch Syndrome： A Rare Case Report and Review of Literature

Wang

et al. 2022

Front. Oncol.

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BackgroundMalignant transformation of deep infiltrating endometriosis (DIE) invading the cervix and rectum is quite rare, especially in patients combined with Lynch syndrome (LS). We report a rare case of a 49-year-old perimenopausal woman with endometrioid carcinoma arising from the pouch of Douglas, invading the cervix and rectum 1 year after a unilateral salpingo-oophorectomy treatment for ovarian endometriosis. The genetic testing of the patient showed germline mutations in MSH2, which combined with the special family history of colorectal cancer of the patient, was also thought to be associated with LS. We have analyzed the reported cases of DIE malignant transformation over the last 10 years, and reviewed the relevant literature, in order to strengthen the clinical management of patients with endometriosis, particularly patients with DIE, and reveal a possible correlation between malignant transformation of endometriosis and LS.Case PresentationA 49-year-old perimenopausal woman presented with hypogastralgia, diarrhea, and intermittent fever for more than 1 month. A Transvaginal ultrasound (TVS) showed a cervix isthmus mass, and a magnetic resonance imaging (MRI) showed a mass in pouch of Douglas with high suspicion of malignancy, possibly invading the anterior wall of the rectum. Prior to surgery, the patient performed the ultrasound guided pelvic mass biopsy through the vagina, and the pathology of the mass showed endometrioid carcinoma. The patient received a gynecological–surgical laparotomy and enterostomy, and a histopathology revealed endometrioid carcinoma infiltrating the cervical wall and rectal wall. In the family genetic history of the patient, her mother and two sisters suffered from colorectal cancer, so lesion tissue and blood were taken for genetic testing, which showed a germline mutation in MSH2, with LS being considered. After the surgical treatment, the patient received six courses of paclitaxel–carboplatin chemotherapy. During the course of treatment, bone marrow suppression occurred, but was healed after symptomatic treatment. To date, the patient is generally in good health, and imaging examination showed no evidence of recurrence.ConclusionThe risk of malignant transformation of endometriosis is increased in perimenopause and postmenopause, as DIE is a rare malignant transformation of endometriosis. DIE can invade other adjacent organs and cause poor prognosis, thus, comprehensive gynecological–surgical treatment should be necessary. In addition, if histopathology showed endometrioid carcinoma, the possibility of LS should be considered, and if necessary, immunohistochemical staining and gene detection should be improved to provide follow-up targeted therapy and immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Deep Infiltrating Endometriosis Malignant Invasion of Cervical Wall and Rectal Wall With Lynch Syndrome： A Rare Case Report and Review of Literature

Wang

et al. 2022

Front. Oncol.

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“…Approximately 1–2% of ovarian and extragenital endometriosis reportedly transform to malignancy. ( Yang et al, 2019 ) Clear cell adenocarcinoma is common in ovarian carcinomas developing from endometriomas. However, in extraovarian sites it accounts for only 4.5% of those cases.…”

Section: Discussionmentioning

confidence: 99%

Menstural function preservation treatment of a primary vaginal clear cell carcinoma with ovarian transposition and vaginal brachytherapy

Vlachos

Πρωτόπαπας

Vlachos

et al. 2021

Gynecologic Oncology Reports

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Highlights Intravaginal brachytherapy can be utilized as a fertility sparing treatment for early stage vaginal carcinomas. Side effects of vaginal brachytherapy are minimal and well tolerated. Transposition of the ovaries should be performed after full surgical staging to preserve their function. The tubes can be preserved during this procedure for future reconstruction.

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“…The preferred sites of DIE in the pelvis are the uterosacral ligament and rectovaginal septum, and there are several reports of malignancies arising from these areas. Recently, Yang et al reported and reviewed the 10 cases of malignant tumors located in the rectovaginal septum related to endometriosis [ 13 ]. Although even more rare, Tarumi et al reported and reviewed 9 cases of malignant transformation arising from DIE in the bladder [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Primary endometrioid carcinoma of the uterosacral ligament arising from deep infiltrating endometriosis 6 years after bilateral salpingo-oophorectomy due to atypical proliferative endometrioid tumor of the ovary: a rare case report

Ota

Takahashi

et al. 2020

World J Surg Onc

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Background Endometriosis can potentially lead to the development of a malignant tumor. Most malignant tumors arising from the endometriosis originate from the ovarian endometrioma, whereas those arising from extragonadal lesions are rare. We report a rare case of endometrioid carcinoma that developed from deep infiltrating endometriosis in the uterosacral ligament 6 years after treatment for atypical proliferative endometrioid tumor of the ovary in a 48-year-old woman. Case presentation Six years ago, the patient underwent laparoscopic bilateral salpingo-oophorectomy for her right ovarian tumor with atypical proliferative (borderline) endometrioid tumor accompanied by ovarian endometrioma. The solid tumor in the cul-de-sac was detected during follow-up using magnetic resonance imaging. Positron emission tomography/computed tomography revealed an abnormal accumulation of 18F-fluorodeoxyglucose at the tumor site. Thus, tumor recurrence with borderline malignancy was suspected. The patient underwent diagnostic laparoscopy followed by hysterectomy and partial omentectomy. Retroperitoneal pelvic lymphadenectomy and para-aortic lymphadenectomy were also performed. The cul-de-sac tumor at the left uterosacral ligament was microscopically diagnosed as invasive endometrioid carcinoma arising from deep infiltrating endometriosis. The final diagnosis was primary stage IIB peritoneal carcinoma. The patient received six courses of monthly paclitaxel and carboplatin as adjuvant chemotherapy. The patient showed no evidence of recurrence for 2 years after the treatments. Conclusion This study reports a rare case of metachronous endometriosis-related malignancy that developed 6 years after treatment for borderline ovarian tumor. If endometriosis lesions remain after bilateral salpingo-oophorectomy, the physician should keep the malignant nature of endometriosis in mind.

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Endometrioid adenocarcinoma of the rectovaginal septum with invasion of the rectum: a case report and review of literature

Cited by 14 publications

References 29 publications

Deep Infiltrating Endometriosis Malignant Invasion of Cervical Wall and Rectal Wall With Lynch Syndrome： A Rare Case Report and Review of Literature

Deep Infiltrating Endometriosis Malignant Invasion of Cervical Wall and Rectal Wall With Lynch Syndrome： A Rare Case Report and Review of Literature

Menstural function preservation treatment of a primary vaginal clear cell carcinoma with ovarian transposition and vaginal brachytherapy

Primary endometrioid carcinoma of the uterosacral ligament arising from deep infiltrating endometriosis 6 years after bilateral salpingo-oophorectomy due to atypical proliferative endometrioid tumor of the ovary: a rare case report

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