{"paper_id":"37623e5e-7da0-4740-96ed-30800366660a","body_text":"Vol.:(0123456789)\nDigestive Diseases and Sciences (2025) 70:2229–2232 \nhttps://doi.org/10.1007/s10620-025-08988-y\nIMAGE OF THE MONTH\nA Case of Uterine Adenosarcoma and Colonic Endometriosis \nMasquerading as Inflammatory Bowel Disease\nChia‑Jou Lin1 · Ying‑Cheng Chiang1 · Tung‑Hung Su2,3 · I‑Lun Shih4 · Kuan‐Ting Kuo5 · Shu‑Chen Wei2 · Yi‑Jou Tai1\nReceived: 17 February 2025 / Accepted: 11 March 2025 / Published online: 21 March 2025 \n© The Author(s) 2025\nAbstract\nBackground Endometriosis is a prevalent gynecological condition that primarily affects women of reproductive age. When \nthegastrointestinal system is involved, it can lead to bowel dysfunction and pose diagnostic challenges.\nAims To present a rare case of gastrointestinal endometriosis with concurrent uterine adenosarcoma, highlighting thediag-\nnostic complexities and therapeutic considerations.\nMethods A 42-year-old female presented with refractory bloody diarrhea, abdominal pain, and significant unintentional \nweightloss for several months. Initial investigations, including stool studies and inflammatory markers, ruled out infectiousand \ncommon inflammatory causes. Endoscopic evaluation revealed multiple polypoid lesions, prompting furtherimaging. Mag-\nnetic resonance enterography (MRE) identified a uterine mass with suspected extrauterine involvementand a rectal nodule, \nraising concerns for malignancy or extensive gastrointestinal endometriosis. The patientunderwent surgical management, \nincluding total hysterectomy, bilateral salpingo-oophorectomy, and lower anteriorresection.\nResults Histopathological analysis confirmed the coexistence of uterine adenosarcoma and rectal endometriosis. The patient-\nfully recovered after surgery without complications. At her 12-month follow-up, she remained asymptomatic, with noevidence \nof recurrence or residual disease.\nConclusions This case underscores the diagnostic and therapeutic challenges of gastrointestinal endometriosis, particularly \nin thepresence of coexisting malignancy. A multidisciplinary approach is essential for early recognition and promptinterven-\ntion, which are crucial for improving patient outcomes and quality of life.\nKeywords Rectum · Inflammatory disease · Adenomyosis · Neoplasms\nExtended author information available on the last page of the article\n\n2230 Digestive Diseases and Sciences (2025) 70:2229–2232\nFig. 1  Magnetic resonance \nenterography findings. A Axial \nhalf-Fourier acquisition single-\nshot turbo spin-echo (HASTE) \nimage shows ill-defined \nT2-hypointensity lesions of the \nuterus, suggestive of adeno-\nmyosis (white arrowheads). At \nthe posterior aspect of uterus, \nthere is a large irregular mass \nwith heterogeneous T2-hyperin-\ntensity (arrows), suspicious for \nmalignancy. In addition, there \nis a T2-hypointense submucosal \nnodule (2.3 cm in size) at the \nanterior wall of the rectum, sug-\ngestive of endometriosis (black \narrowhead). B Coronal HASTE \nimage shows the irregular \nT2-hyperintense uterine mass \n(arrows). C Axial diffusion-\nweighted image shows focal \nhigh signal intensity of the mass \n(arrow), suggestive of increased \ncellularity. D Axial post-con-\ntrast T1-weighted image shows \nheterogeneous enhancement of \nthe uterine mass (arrows) with \nfocal non-enhancing necrotic \nareas. The rectal nodule (arrow-\nhead) shows mild enhancement\nFig. 2  Operative findings and the excised specimen. A On entry of abdomen, severe adhesion of descending colon on posterior uterine wall \nnoted. The uterine corpus showed extensive adenomyosis. B Rectal endometriosis with full penetration into the mucosa\n\n2231Digestive Diseases and Sciences (2025) 70:2229–2232 \nA 42-year-old woman presented with a month-long history \nof mucoid bloody diarrhea, weight loss, and worsening \nbowel symptoms. Despite empirical treatment, her condition \ndeteriorated, prompting further evaluation. Initial tests ruled \nout infections, and colonoscopy showed no active inflam-\nmation. However, magnetic resonance enterography (MRE) \nrevealed an 8 cm uterine mass suspicious for malignancy \nand a rectal nodule suggesting endometriosis [1, 2] (Fig.  1). \nElevated CA-125 and CA19-9 supported these findings. She \nunderwent hysterectomy, bilateral salpingo-oophorectomy, \nand rectal tumor resection (Fig.  2). Pathology confirmed \nuterine adenosarcoma (FIGO stage I) [3 ] and rectal endo-\nmetriosis (Fig.  3). Post-surgery, she remained disease-free \nfor 12 months, with complete resolution of symptoms.  \nAuthor Contributions Conceptualization, data curation, formal analy-\nsis, methodology: Lin CJ. Project administration: Wei SC. Resources: \nTai YJ, Chiang YC, Su TH, Shih IL, Kuo KT, Wei SC. Supervision: \nKuo KT, Wei SC. Visualization: Tai YJ, Chiang YC, Su TH. Writing—\noriginal draft: Lin CJ, Tai YJ. Writing—review & editing: all authors. \nApproval of final manuscript: all authors.\nFunding The authors received no financial support for the research, \nauthorship, and/or publication of this article.\nData Availability No datasets were generated or analyzed during the \ncurrent study.\nDeclarations \nConflict of interest The authors declare no competing interests.\nFig. 3  Representative images of H&E, IHC staining and FISH \nanalysis in surgical specimens. A The uterus exhibited extensive \nadenomyosis with endometrial glands and stroma surrounded by \nhypertrophic smooth muscle cells. B In adenomyosis without atypi-\ncal changes (B1), stromal cells showed focal p16 (B2) but no CDK4 \nprotein expression (B3). Foci of atypical stromal cells with pleomor -\nphic hyperchromatic nuclei arise in and spreading along adenomyosis \n(B4). These atypical stromal cells are diffusely positive for p16 (B5) \nand CDK4 (B6) expression. C Evident necrosis in atypical stromal \ncells with focally but strongly MDM2 protein expression (C1, C2). \nFluorescent in  situ hybridization showed MDM2 and CDK4 ampli-\nfication consistent with the diagnosis of adenosarcoma (C3: MDM2-\nred signals, CEP12-green signals, C4: 3' DDIT3-orange signals, 5' \nDDIT3-green signals). D Endometriosis in rectal tumor (inset figure) \ncomprised bland-appearing stromal cells (H&E)\n\n2232 Digestive Diseases and Sciences (2025) 70:2229–2232\nOpen Access This article is licensed under a Creative Commons Attri-\nbution-NonCommercial 4.0 International License, which permits any \nnon-commercial use, sharing, adaptation, distribution and reproduction \nin any medium or format, as long as you give appropriate credit to the \noriginal author(s) and the source, provide a link to the Creative Com-\nmons licence, and indicate if changes were made. The images or other \nthird party material in this article are included in the article’s Creative \nCommons licence, unless indicated otherwise in a credit line to the \nmaterial. If material is not included in the article’s Creative Commons \nlicence and your intended use is not permitted by statutory regula-\ntion or exceeds the permitted use, you will need to obtain permission \ndirectly from the copyright holder. To view a copy of this licence, visit \nhttp://creativecommons.org/licenses/by-nc/4.0/.\nReferences\n 1. Radzynski L, Boyer L, Kossai M, et al. Pictorial essay: MRI evalu-\nation of endometriosis-associated neoplasms. Insights Imaging . \n2023;14:144.\n 2. Fiorillo M, Neri B, Mancone R, et al. Inflammatory bowel dis-\nease and endometriosis: diagnosis and clinical characteristics. \nBiomedicines. 2024;12:2521.\n 3. Mbatani N, Olawaiye AB, Prat J. Uterine sarcomas. Int J Gynaecol \nObstet. 2018;143:51–58.\nPublisher's Note Springer Nature remains neutral with regard to \njurisdictional claims in published maps and institutional affiliations.\nAuthors and Affiliations\nChia‑Jou Lin1 · Ying‑Cheng Chiang1 · Tung‑Hung Su2,3 · I‑Lun Shih4 · Kuan‐Ting Kuo5 · Shu‑Chen Wei2 · Yi‑Jou Tai1\n * Yi-Jou Tai \n yijoutai1982@ntuh.gov.tw\n1 Department of Obstetrics and Gynecology, College \nof Medicine, National Taiwan University, Taipei, Taiwan\n2 Department of Internal Medicine, National Taiwan \nUniversity Hospital, Taipei, Taiwan\n3 Hepatitis Research Center, National Taiwan University \nHospital, Taipei, Taiwan\n4 Department of Medical Imaging, National Taiwan University \nHospital, Taipei, Taiwan\n5 Department of Pathology, National Taiwan University \nHospital, Taipei, Taiwan","source_license":"CC0","license_restricted":false}