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Endometrial cancer metastatic to the transverse colon mimicking colorectal cancer

Published:January 09, 2023DOI:https://doi.org/10.1016/j.amjms.2023.01.001

      Case Presentation

      A 68-year-old woman presented with a month history of formless stool. She had received hysterectomy for endometrial cancer 2 years ago. The level of cancer antigen 125 was elevated (46.77 U/mL; normal level, 0–35 U/mL). Other tumor markers were normal, including alpha fetoprotein, carcinoembryonic antigen and cancer antigen 199. Colonoscopy (Fig. 1A) showed a 50% circumferential extent tumor with superficial ulcer in the transverse colon, 60 cm from the anus. Abdominal contrast enhanced CT (Fig. 1B) demonstrated an oval mass involving the anterior wall of the transverse colon (red arrow), approximately 2.4 cm in diameter. A ring-like enhanced oval mass was also revealed in the right paracolic gutter (yellow arrow), approximately 3.2 cm in diameter. No other lesion was found, including the liver and lymph nodes. Photomicrograph of a colonoscopic biopsy of the mass in the transverse colon indicated metastatic endometrioid adenocarcinoma (Fig. 1C: the tumor containing cribriform structure with gland fusion), with the following immunohistochemistry results: Vimentin (+) (Fig. 1D), CDX-2 (-) (Fig. 1E), CK7 (+) (Fig. 1F), P16 (+) (Fig. 1G), CK20 (-), PR (-).
      Common sites for endometrial cancer metastasis can involve most commonly the lymph nodes (48%), followed by the vagina, peritoneum, and lung.
      • Koury E
      • Kawar H
      • Chahla E.
      Metastatic endometrial cancer to the sigmoid colon masquerading as primary colorectal cancer.
      ,
      • Anstadt MJ
      • Lapetino SR
      • Defnet A
      • et al.
      Endometrial adenocarcinoma metastatic to the colon masquerading as a primary colon cancer.
      Metastatic endometrial cancer to the gastrointestinal track is quite rare.
      • Hubers JA
      • Soni A.
      A rare case of endometrial cancer metastatic to the sigmoid colon and small bowel.
      Given that metastatic colon cancer originating from endometrial cancer is mimicking colorectal cancer,
      • Koury E
      • Kawar H
      • Chahla E.
      Metastatic endometrial cancer to the sigmoid colon masquerading as primary colorectal cancer.
      clinicians must therefore keep in mind the possibility of metastatic disease especially when there is a prior history of malignancy.

      Funding

      The author(s) received no financial support for the research, authorship, and/or publication of this article.

      Declaration of Competing Interest

      The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this manuscript.

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