Mixed high-grade serous and large cell neuroendocrine carcinoma arising from rectal endometriosis 11 years after hysterectomy

The malignant gastrointestinal endometriosis transformation is represented by endometriosis-associated intestinal tumors. Endometrioid adenocarcinoma and clear cell adenocarcinoma are most common among the endometrial cancers of all organs. Only four cases of mixed serous carcinoma and large cell neuroendocrine carcinoma have been reported, and all these cases originated from the uterus. A 59-year-old woman with a month’s history of bloody stools was admitted. She was stable until the hematochezia occurred but is 11 years post-hysterectomy. A circumferential type-3 advanced upper rectum tumor was seen on colonoscopy. Adenocarcinoma was revealed from the forceps biopsies of the type-3 tumor component. Computed tomography showed narrowed lumen with a thickened rectum wall, a continuing mass, and a component on the anorectal side. Swollen lymph nodes were observed around the rectum, but no distant metastatic lymph nodes or organs were found. To treat the lesion, rectal surgical resection with D3 lymph node dissection was performed. Histological examination revealed combined high-grade serous and large cell neuroendocrine carcinomas. Tumor was contiguous to the endometrium in the sub-serosa. Endometriosis was determined to be the origin of both carcinomas. Therefore, endometriosis-associated intestinal tumors should be included in the differential diagnosis when rectal tumors with cystic structures are found post-hysterectomy. Similar content being viewed by others

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We would like to express our gratitude to Dr. Yuko Omori of the Tohoku University Department of Investigative Pathology for her pathological evaluation, Dr. Kazunori Otsuka of the Miyagi Cancer Center Department of Medical Oncology for chemotherapy, and all medical staff for their assistance at the Soma General Hospital. Author information Authors and Affiliations Contributions Conceptualization, TY and TH. Methodology, TY, TH, and YW. Formal Analysis, TY Investigation, TY, YW, HS, YT, NA, CH, and HK. Resources, TY, TH, and YW Writing–Original Draft Preparation, TY and TH Writing–Review and Editing, YW and MK. Supervision, HO. All authors have read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest Takumi Yanagita, Takuto Hikichi, Yuichi Waragai, Hiroshi Shimizu, Yuta Takahashi, Naoto Abe, Choichiro Hashimoto, Hiromi Kumakawa, Masao Kobayakawa, Hiromasa Ohira declare that they have no conflict of interest. Human and animal rights All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent Informed consent was obtained from this patient for being included in the paper. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Yanagita, T., Hikichi, T., Waragai, Y. et al. Mixed high-grade serous and large cell neuroendocrine carcinoma arising from rectal endometriosis 11 years after hysterectomy. Clin J Gastroenterol 16, 366–371 (2023). https://doi.org/10.1007/s12328-023-01769-y Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s12328-023-01769-y