A Case of Endometrioid Adenocarcinoma arising from Rectal Endometriosis Seventeen Years after an Operation for Endometriosis

Tatsuya Manabe, Keiichi Uto, Yuji Ueda and Kiyokazu Toyota

Department of Surgery, Miyazaki Prefectural Miyazaki Hospital

We report a case of endometrioid adenocarcinoma arising from rectal endometriosis 17 years after endometriosis surgery. A 54-year-old woman who underwent hysterectomy and left salpingo-oophorectomy for endometriosis at 37 years of age and unopposed estrogen therapy for 16 years developed lower abdominal pain after eating. Colonoscopy and barium enema showed a submucosal tumor in the left anterior wall of the middle third portion of the rectum that led to rectal narrowing. Positron emission tomography with fluorodeoxyglucose (FDG) showed only FDG accumulation in the same region. A biopsy specimen showed well-differentiated adenocarcinoma in which carcinoma cells were positive for cytokeratin 7 but negative for cytokeratin 20, yielding a definitive diagnosis of endometriosis-associated intestinal tumor (EAIT) necessitating low anterior resection. The histological diagnosis was endometrioid adenocarcinoma, and endometrial glands were seen in an adjacent tissue, together with regional lymph node metastases. Adjuvant paclitaxel and carboplatin therapy was then done. An intestinal tumor in a woman with a history of treatment for endometriosis and unopposed estrogen therapy should include the consideration of a differential EAIT diagnosis.

Key words
EAIT, endometriosis-associated intestinal tumor, rectal tumor

Reprint requests
Tatsuya Manabe Department of Surgery, Miyazaki Prefectural Miyazaki Hospital
5-30 Kitatakamatucho, Miyazaki, 880-8510 JAPAN

Accepted
June 18, 2009

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