Limits...
Endometrial stromal sarcoma arising in colorectal endometriosis: a case report and review of the literature.

Wang Q, Zhao X, Han P - Case Rep Obstet Gynecol (2015)

Bottom Line: We reported a case of ESS arising in colorectal endometriosis and reviewed the previous 7 cases reported in the English literature.Our patient, who was unavailable for tumor resection and refused further adjuvant therapy, played a role in representing the natural history of low-grade extragenital ESS.This case was the only death from ESS arising in colorectal endometriosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology & Obstetrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

ABSTRACT
Extrauterine endometrial stromal sarcoma (ESS) arising in endometriosis is extremely rare, particularly in the colorectum. It should always be included in the differential diagnosis of primary tumors originating from gastrointestinal tract in females, given that preoperative endoscopical biopsy may reveal no specific changes. We reported a case of ESS arising in colorectal endometriosis and reviewed the previous 7 cases reported in the English literature. Our patient, who was unavailable for tumor resection and refused further adjuvant therapy, played a role in representing the natural history of low-grade extragenital ESS. This case was the only death from ESS arising in colorectal endometriosis.

No MeSH data available.


Related in: MedlinePlus

Abdominal and pelvic computed tomographic scan demonstrated thickening of rectal wall with inhomogeneous enhancement and a 4 cm soft tissue mass that involved the rectum and left ovary. Right hydronephrosis and hydroureter were also revealed.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4306220&req=5

fig1: Abdominal and pelvic computed tomographic scan demonstrated thickening of rectal wall with inhomogeneous enhancement and a 4 cm soft tissue mass that involved the rectum and left ovary. Right hydronephrosis and hydroureter were also revealed.

Mentions: A 40-year-old, gravida 3, para 2, woman presented with change in bowel habits and bright red rectal bleeding which had lasted for 1 year. She had a history of subtotal abdominal hysterectomy for uterine leiomyoma performed 3 years before and a history of right ovarian cystectomy. She denied any symptoms or presentations of endometriosis and had no history of hormone replacement therapy. Digital rectal examination revealed a fixed and firm mass with blood. Her serum carcinoembryonic antigen levels were in normal limits. The laboratory tests showed no remarkable abnormality except for a moderate anemia. Abdominal and pelvic computed tomographic (CT) scan demonstrated thickening of rectal wall with inhomogeneous enhancement and a 4 cm soft tissue mass that involved the rectum and left ovary (Figure 1). The CT scan also revealed right hydronephrosis and hydroureter. On colonoscopic examination, a protruding lesion in the rectum and segmental stenoses of the rectosigmoid lumen were found. Endoscopic biopsy reported tubular adenoma and proliferation of spindle cells at the edge of tissue. Laparotomy was performed under the clinical consideration of gastrointestinal stromal tumor (GIST) or carcinoma developed on the rectum. On operation, nodular masses (1–3 cm in diameter) were found generally scattered in the intestinal walls and mesentery. Frozen section examination of nodules reported the exhibition of endometrial glands and whirling proliferation of plump spindle cells, considering extrauterine ESS as a clinicopathologic diagnosis. Because of the extensive intra-abdominal metastases and adhesion, the lesion was unresectable. The patient underwent intraoperative peritoneal chemotherapy and palliative transverse colostomy to relieve the stenosis. On immunohistochemical stain, the tumor cells were diffusely positive for CD 10, estrogen, and progesterone receptors (and 7% positive for Ki-67) but negative for CD 117, α-inhibin, desmin, smooth muscle actin, caldesmon, CD 34, and S-100. The diagnosis of low-grade ESS was made. After surgery, the patient refused further chemotherapy or radiotherapy. She died associated with this disease 18 months after diagnosis.


Endometrial stromal sarcoma arising in colorectal endometriosis: a case report and review of the literature.

Wang Q, Zhao X, Han P - Case Rep Obstet Gynecol (2015)

Abdominal and pelvic computed tomographic scan demonstrated thickening of rectal wall with inhomogeneous enhancement and a 4 cm soft tissue mass that involved the rectum and left ovary. Right hydronephrosis and hydroureter were also revealed.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4306220&req=5

fig1: Abdominal and pelvic computed tomographic scan demonstrated thickening of rectal wall with inhomogeneous enhancement and a 4 cm soft tissue mass that involved the rectum and left ovary. Right hydronephrosis and hydroureter were also revealed.
Mentions: A 40-year-old, gravida 3, para 2, woman presented with change in bowel habits and bright red rectal bleeding which had lasted for 1 year. She had a history of subtotal abdominal hysterectomy for uterine leiomyoma performed 3 years before and a history of right ovarian cystectomy. She denied any symptoms or presentations of endometriosis and had no history of hormone replacement therapy. Digital rectal examination revealed a fixed and firm mass with blood. Her serum carcinoembryonic antigen levels were in normal limits. The laboratory tests showed no remarkable abnormality except for a moderate anemia. Abdominal and pelvic computed tomographic (CT) scan demonstrated thickening of rectal wall with inhomogeneous enhancement and a 4 cm soft tissue mass that involved the rectum and left ovary (Figure 1). The CT scan also revealed right hydronephrosis and hydroureter. On colonoscopic examination, a protruding lesion in the rectum and segmental stenoses of the rectosigmoid lumen were found. Endoscopic biopsy reported tubular adenoma and proliferation of spindle cells at the edge of tissue. Laparotomy was performed under the clinical consideration of gastrointestinal stromal tumor (GIST) or carcinoma developed on the rectum. On operation, nodular masses (1–3 cm in diameter) were found generally scattered in the intestinal walls and mesentery. Frozen section examination of nodules reported the exhibition of endometrial glands and whirling proliferation of plump spindle cells, considering extrauterine ESS as a clinicopathologic diagnosis. Because of the extensive intra-abdominal metastases and adhesion, the lesion was unresectable. The patient underwent intraoperative peritoneal chemotherapy and palliative transverse colostomy to relieve the stenosis. On immunohistochemical stain, the tumor cells were diffusely positive for CD 10, estrogen, and progesterone receptors (and 7% positive for Ki-67) but negative for CD 117, α-inhibin, desmin, smooth muscle actin, caldesmon, CD 34, and S-100. The diagnosis of low-grade ESS was made. After surgery, the patient refused further chemotherapy or radiotherapy. She died associated with this disease 18 months after diagnosis.

Bottom Line: We reported a case of ESS arising in colorectal endometriosis and reviewed the previous 7 cases reported in the English literature.Our patient, who was unavailable for tumor resection and refused further adjuvant therapy, played a role in representing the natural history of low-grade extragenital ESS.This case was the only death from ESS arising in colorectal endometriosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology & Obstetrics, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

ABSTRACT
Extrauterine endometrial stromal sarcoma (ESS) arising in endometriosis is extremely rare, particularly in the colorectum. It should always be included in the differential diagnosis of primary tumors originating from gastrointestinal tract in females, given that preoperative endoscopical biopsy may reveal no specific changes. We reported a case of ESS arising in colorectal endometriosis and reviewed the previous 7 cases reported in the English literature. Our patient, who was unavailable for tumor resection and refused further adjuvant therapy, played a role in representing the natural history of low-grade extragenital ESS. This case was the only death from ESS arising in colorectal endometriosis.

No MeSH data available.


Related in: MedlinePlus