Müllerian Carcinosarcoma Arising From Intestinal Endometriosis

Abstract

She did not have any nausea, vomiting, fever, weight loss, or blood in her stools. She had a remote history of endometriosis requiring a total abdominal hysterectomy with bilateral salphingo-oophorectomy and has been taking estrogen 0.625 mg once per day for the 40 years since. She had no known family history of cancer. On examination, the patient was not in any distress and vital signs were stable. Her body mass index was 30.2 (weight, 75 kg; height, 62 inches). Her abdomen was not tender but a soft, large, palpable anterior pelvic mass was noted. There were no vaginal lesions, bleeding, or discharge noted on pelvic examination. There were no signs of fecal impaction or rectal bleeding. Complete blood count and basic metabolic panels were normal. A computed tomography scan of the abdomen and pelvis revealed a 13 ϫ 10 ϫ 11-cm solid and cystic mass in close proximity with the sigmoid colon causing obstruction (Fig 1). The uterus and ovaries were not visualized and there were no noticeable signs of metastasis. Serum carcinoembryonic antigen was 3.3 and CA-125 was 14.6. The patient was admitted to our hospital and underwent an exploratory laparotomy. It revealed a large pelvic mass that was adherent to the lower sigmoid colon, which required a partial colectomy with en bloc tumor resection and primary anastomosis. There was no evidence of metastatic disease within the liver or peritoneum and no palpable lymph nodes were present within the mesentery. Gross findings consisted of a partially ruptured, lobulated, red-tan mass that measured 15 ϫ 12 ϫ 5 cm attached to the colon. Histologic sections of the colonic segment demonstrated marked bowel wall thickening owing to the presence of

Carcinosarcoma arising from uterine adenomyosis: A case report

“…Extraovarian carcinosarcoma is reportedly strongly associated with unopposed estrogen replacement . In the previously reported five cases of carcinosarcoma originating from extraovarian endometriosis, three occurred after estrogen‐replacement treatment or exogenous estrogen use . However, this did not apply to our patient.…”

“…3 In the previously reported five cases of carcinosarcoma originating from extraovarian endometriosis, three occurred after estrogen-replacement treatment or exogenous estrogen use. 5,6,8 However, this did not apply to our patient.…”

“…There are case reports of carcinosarcoma originating from extraovarian endometriosis. The primary sites reported in the English literature are the small intestine, retroperitoneum, ureter and cesarean section scar …”

“…The primary sites reported in the English literature are the small intestine, retroperitoneum, ureter and cesarean section scar. [5][6][7][8][9] On the other hand, Koike et al reviewed 34 cases of malignant transformation of uterine adenomyosis reported in the English literature from 1986. 10 There were 23 cases of endometrioid adenocarcinoma, three clear cell adenocarcinoma, two serous adenocarcinomas, five serous endometrial intraepithelial carcinomas and one Müllerian adenosarcoma.…”

Mullerian carcinosarcoma in the colon of a patient with history of endometrial carcinoma: A case report and insight into possible pathogenesis

“…Endometriosis is frequently multifocal, far more common than endosalpingiosis in the pelvis (ratio of 15:1) ( Quddus et al, 2000 ). It occurs in the bowel in about 37% of patients ( Agito et al, 2013 ) and can serve as a microenvironment for potential malignant transformation ( Slavin et al, 2000 ). Malignant transformation of endometriosis (also known as endometriosis associated intestinal tumor) has been described in the literature, with 77% of cases occurring in the rectosigmoid colon.…”