Metastatic endometrial cancer; a rare intestinal localization

Abstract

togenous metastases, most often in lungs, brain, and bones. We describe a patient with metastases of endometrial cancer in the small bowel. An 85−year−old female patient was ad− mitted with severe anemia and melena. She had endometrial cancer (Figo stage IIIB), 2 years previously, for which she un− derwent an operation and received adju− vant radiotherapy. She was admitted with severe anemia (Hb 3.8 mmol/L) and melena. Upper endoscopy did not reveal any abnormalities. Colonoscopy was nor− mal. Video capsule endoscopy was carried out. With this examination, two tumors were discovered with signs of recent hemor− rhage (adherent clot) (l Figure 1). Dur− ing laparotomy, a large tumor in the small bowel was encountered. A large part of the small bowel was resected. An end−to− end enteroenterostomy was carried out. Histological examination showed a carci− nosarcoma with extensive angioinvasive growth. The immunohistochemical pic− ture was identical to the endometrial tu− mor, which was removed in 2004. As well as features of a carcinoma, signs of a sarcoma were also seen, compatible with tumor differentiation (l Figure 2 a and l 2 b). On the basis of the initial stage of the en− dometrial carcinoma (Figo IIIB), this pa− tient was at risk for developing metasta− ses. In this group of patients, the majority develops metastases within 3 years, most often in the peritoneal cavity, lungs, liver, bones, or brain. Intestinal metastases of endometrial can− cer have been described in the literature, but are rarely seen. Biegel et al. describe bleeding colonic metastases in a patient with endometrial cancer [1]. Metastases in the small bowel have also been de− scribed [2], sometimes requiring segmen− tal small−bowel resection because of bleeding complications [3]. The small−bowel metastases caused mas− sive bleeding and were diagnosed by means of videocapsule endoscopy. With the introduction of this diagnostic tool, access to the small bowel and diagnostic yield have improved significantly.