Open Access Case report

Metachronic malignant transformation of small bowel and rectal endometriosis in the same patient

Joaquin Marchena-Gomez1*, Alicia Conde-Martel2, Marion Hemmersbach-Miller2 and Ana Alonso-Fernandez3

Author Affiliations

1 Department of General Surgery, University Hospital Gran Canaria "Dr. Negrin", Las Palmas G.C., Spain

2 Department of Internal Medicine, University Hospital Gran Canaria "Dr. Negrin", Las Palmas G.C., Spain

3 Department of Pathology, University Hospital Gran Canaria "Dr. Negrin", Las Palmas G.C., Spain

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World Journal of Surgical Oncology 2006, 4:93  doi:10.1186/1477-7819-4-93

Published: 12 December 2006

Abstract

Background

Malignant transformation of intestinal endometriosis is a rare event with an unknown rate of incidence. Metachronous progression of endometriosis to adenocarcinoma from two distant intestinal foci happening in the same patient has not been previously reported.

Case presentation

We describe a case of metachronic transformation of ileal and rectal endometriosis into an adenocarcinoma occurring in a 45-year-old female without macroscopic pelvic involvement of her endometriosis. First, a right colectomy was performed due to intestinal obstruction by an ileal mass. Pathological examination revealed an ileal endometrioid adenocarcinoma and contiguous microscopic endometriotic foci. Twenty months later, a rectal mass was discovered. An endoscopic biopsy revealed an adenocarcinoma. En bloc anterior rectum resection, hysterectomy and bilateral salpingectomy were performed. A second endometrioid adenocarcinoma arising from a focus of endometriosis within the wall of the rectum was diagnosed.

Conclusion

Intestinal endometriosis should be considered a premalignant condition in premenopausal women.