Case Report
Obstructing Colonic Mass: A Case of Recurrent
Endometrial Cancer
Victor Chedid, Mona Arasoghli, and Jana G. Hashash
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA 15213, USA
Correspondence should be addressed to Victor Chedid; vichedid@gmail.com
Received 10 May 2015; Accepted 16 June 2015
Academic Editor: Haruhiko Sugimura
Copyright © 2015 Victor Chedid et al. his is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A 71-year-old female with a history of endometrial cancer presented to our hospital with bilateral lower quadrant abdominal pain,
which had been worsening over the past two months. he pain was associated with constipation, pencil-thin stools, and a 60 lb
weight loss. On physical examination, the patient had suprapubic and let lower quadrant abdominal tenderness. Contrast-enhanced
CT scan revealed a 6 cm pelvic mass in the let lower quadrant. It was unclear if this mass was arising from the sigmoid colon or
abutting it. A colonoscopy to further investigate the mass was pursued and this revealed a moderate 5 cm long stenosis in the sigmoid
colon starting at 15 cm from the anal verge. he stenosis was not ulcerated but had a bluish/purplish hue to it circumferentially.
Multiple biopsies were obtained from that area and these revealed architectural changes with mild ibrosis but no malignancy. he
mass was further explored with CT-guided ine needle aspiration. he results obtained were positive for cytokeratin-7, CA-125,
estrogen receptor protein, and PAX-8 conirming that the mass was endometrial in origin.
1. Introduction
Endometrial cancer is the leading cause of genitourinary
cancers among women in the United States [1]. In general,
if diagnosed early, it has a favorable prognosis. he ive-
year survival for stage I disease is approximately 80 to 90
percent, for stage II it is 70 to 80 percent, and for stages
III and IV it is 20 to 60 percent [2]. Recurrence rates are
relatively low, with the majority of cases recurring within
three years ater treatment. Around 77% of recurrences are
associated with symptoms related to the site of recurrence
[3]. Recurrence sites are evenly distributed between vaginal
vault and distant metastasis (lung or abdominal) [3]. Signs or
symptoms suggestive of recurrence include vaginal bleeding,
abdominal or pelvic pain, persistent cough, or unexplained
weight loss. Hence, in females with a history of gynecological
cancers, including endometrial cancer, it is important to
maintain an index of suspicion for recurrence when they
present with such symptoms [3, 4].
2. Case Report
A 71-year-old Caucasian woman, with a remote history of
stage 1 endometrial cancer treated more than 10 years ago
with total abdominal hysterectomy and bilateral oophorec-
tomy (TAHBSO) with no radiation, presented to our institu-
tion with intermittent cramping and bilateral lower quadrant
abdominal pain, progressively worsening over a 2-month
period. his was associated with constipation and thin stools.
She also reported a 60 lb weight loss over the past year.
She denied any nausea, vomiting, hematochezia, or melena.
She also denied fevers, chills, or night sweats. Physical
examination revealed a tender abdomen mainly over the
suprapubic area and the let lower quadrant. No guarding
or rebound tenderness was appreciated. Bowel sounds were
normoactive.
A CT scan was performed and showed a 6 cm pelvic mass
in the let lower quadrant(Figure 1(a)). It was unclear if this
mass was arising from the sigmoid colon or abutting it. A
colonoscopy was pursued to further evaluate the patient’s
symptoms and investigate the radiographic indings. here
was a moderate stenotic area measuring 5 cm in length in
the sigmoid colon starting at 15 cm from the anal verge.
his area was easily traversed with an adult colonoscope.
he stenosis was not ulcerated but had a bluish/purplish
hue to it circumferentially (Figures 1(b) and 1(c)) suspicious
for malignant iniltration or extrinsic compression. Multiple
biopsies were obtained from that area and these revealed
Hindawi Publishing Corporation
Case Reports in Gastrointestinal Medicine
Volume 2015, Article ID 593786, 3 pages
http://dx.doi.org/10.1155/2015/593786