Unusual Presentation of Recurrent Early Stage Endometrial Carcinoma 28 Years after Primary Surgery

Abstract

Endometrial carcinoma is the most common neoplasia of female genital tract. The prognosis of early stage disease (FIGO I and FIGO II) is excellent: recurrence after surgery is less than 15%, most of which are reported within 3 years after primary treatment. Herein we report a case of late rectal recurrence from FIGO Ib endometrial adenocarcinoma. Patient had also familiar and personal history of colonic adenocarcinoma and previous findings of microsatellite instability (MSI); molecular analysis evidenced heterozygotic somatic mutation in MLH1 gene. Twenty-eight years after hysterectomy and bilateral salpingoovariectomy, a rectal wall mass was detected during routine colonoscopy. Patients underwent CT scan, pelvic MRI, and rectal EUS with FNA: histopathological and immunohistochemical analysis revealed differentiated carcinoma cells of endometrial origin. No neoadjuvant treatment was planned and low rectal anterior resection with protective colostomy was performed; histology confirmed rectal lesion as metastasis from endometrial carcinoma. Recurrence of early stage endometrial carcinoma after a long period from primary surgery is possible. It is important to keep in mind this possibility in order to set a correct diagnostic and therapeutic algorithm, including preoperative immunohistochemical staining, and to plan a prolonged follow-up program.

Large bowel recurrence of endometrial adenocarcinoma years after treatment: A single-institution case series and review of the literature

“… Genetic susceptibility? Bailey and Gilbert (2002) Not included in publication endometroid Surgery 1 RT 2 5 yrs 3 Rectal Not stated Not stated Bailey and Gilbert (2002) Not included in publication endometrioid Surgery 1 RT 2 7 yrs 3 Rectal Not stated Not stated Addison et al (2012) 1B/3 Adeno-squamous Surgery 1 EBRT 10 yrs 3 Appendix Not stated Not stated Anstadt et al (2012) 1B/2 Endometrioid Surgery 1 No 17 mo Recto-sigmoid No Not stated Wou et al (2014) 1B/2 Endometrioid Complete surgical staging 4 No 7 yrs Rectal Not stated Not stated Chedid et al (2015) 1B/Unknown Endometrioid Surgery 1 No >10 yrs 3 Sigmoid Not stated Not stated Franchello et al (2015) 1B/”Low-grade” Endometroid Surgery 1 VCBT >28 yrs 3 Rectal No MLH1 som...…”

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

“…This tumor is the most common cause of malignant neoplasia of the female genital tract. 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 ].…”

“…Endometrial adenocarcinoma is the most common malignant neoplasm of the female genital tract [ 1 ]. In the early stages, its treatment has a good prognosis with little recurrence both local and distant.…”

Ferroptosis: Opportunities and Challenges in Treating Endometrial Cancer

“…Endometrial cancers metastasize mainly through lymphatic metastasis and local invasive metastasis, but less through hematogenous metastasis. It has been reported that 71% of stage 3 patients experience distant metastasis (Tangjitgamol et al, 2004;Franchello et al, 2015), and that 15% of patients with FIGO I and II endometrial cancer undergo recurrences, especially those who had deep myometrial invasion and lymphovascular invasion (Fung- Kee-Fung et al, 2006;Sartori et al, 2010). Since metastasis and recurrence are closely associated with prognosis of endometrial cancer, the 5-year overall survival (OS) rates of patients with metastasis, pelvic recurrence, and extrapelvic recurrence were lower than those of the localized endometrial carcinoma (16, 55 and 17% vs. 95%) (Xu et al, 2016;National Cancer Institute Surveillance, 2017).…”