A case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery

Yu Okazawa, Rina Takahashi, Kosuke Mizukoshi, Kazuhiro Takehara, Shun Ishiyama, Kiichi Sugimoto, Makoto Takahashi, Yutaka Kojima, Michitoshi Goto, Atsushi Okuzawa, Yuichi Tomiki, Takashi Yao, Kazuhiro Sakamoto
International journal of surgery case reports · 2014 · vol. 5(12) , pp. 979–983 · doi:10.1016/j.ijscr.2014.10.034 · PMID:25460452 · PMC4276269 · W2105111700
article OA: gold CC0 ⤵ 13 in-corpus citations
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This report details a rare case of laparoscopic surgery for a clear cell adenocarcinoma originating from rectal endometriosis in an 83-year-old woman, with no recurrence observed 18 months post-operation.

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Abstract

Malignant transformation of intestinal endometriosis occurring in the extraovarian sites is extremely rare. We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the rectum. An 83-year-old woman was admitted with the complaint of hematochezia. Colonoscopy revealed a tumor around about half of the rectal circumference. Biopsy of the tumor revealed a well-differentiated adenocarcinoma. Low anterior resection was undergone laparoscopically under the diagnosis of rectal carcinoma. Histopathological examination revealed clear cell adenocarcinoma, invading the sub-serosa of the rectum, but no metastasis of the lymph nodes. Immunohistochemical staining showed strong positivity for cytokeratin 7, but no staining for cytokeratin 20 and CDX2. The tumor existed adjacent to the endometrial glands, which were stained positive for Estrogen receptor. Ultimately, the patient was diagnosed with clear cell adenocarcinoma arising from endometriosis. Eighteen months after surgery, there are no signs of tumor recurrence. Clear cell adenocarcinoma arising from intestinal endometriosis has been reported in 7 cases, including our case. Careful observation is required because the prognosis of endometriosis after malignant transformation remains poor. We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery.

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endometriosis

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