Kawate Susumu, Takeyoshi Izumi, Ikota Hayato, Numaga Yuki, Sunose Yutaka, Morishita Yasuo
Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma 371-8511, Japan.
Jpn J Clin Oncol. 2005 Mar;35(3):154-7. doi: 10.1093/jjco/hyi037.
This report presents a case of endometrioid adenocarcinoma arising from endometriosis of the mesenterium of the sigmoid colon following total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyoma of the uterus and infiltrating pelvic endometriosis, and hormone replacement therapy. A 62-year-old woman presented with an abdominal tumor. Based on the diagnosis of mesocolonic tumor, sigmoidectomy with lymph node resection was performed. The tumor cells were immunopositive for cytokeratin 7, but negative for cytokeratin 20, and the tumor was histologically diagnosed as endometrioid adenocarcinoma of the mesocolon. Hyperestrogenism has been implicated as a risk factor for the development of cancer from endometriosis. The patient had been receiving high-dose unopposed estrogens for 14 years after a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Physicians should recognize that endometriosis-associated neoplasms are able to cause symptoms or signs such as abdominal and/or pelvic pain, pelvic mass, and vaginal bleeding, especially if the patient has been treated with hormone replacement therapy. It is important to recognize the possibility of tumors arising from endometriosis when evaluating intestinal or mesenteric neoplasms in women, even in the patient who has previously undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy, particularly if the patient has a history of endometriosis and has received hormone replacement therapy.
本报告介绍了一例乙状结肠系膜子宫内膜异位症继发子宫内膜样腺癌的病例。患者因子宫平滑肌瘤及盆腔浸润性子宫内膜异位症接受了全腹子宫切除术及双侧输卵管卵巢切除术，并接受了激素替代治疗。一名62岁女性因腹部肿物就诊。基于结肠系膜肿瘤的诊断，实施了乙状结肠切除术及淋巴结切除术。肿瘤细胞细胞角蛋白7免疫阳性，但细胞角蛋白20免疫阴性，组织学诊断为结肠系膜子宫内膜样腺癌。高雌激素状态被认为是子宫内膜异位症发展为癌症的一个危险因素。该患者在全腹子宫切除术及双侧输卵管卵巢切除术后接受了14年的高剂量单一雌激素治疗。医生应认识到，子宫内膜异位症相关肿瘤能够引起腹部和/或盆腔疼痛、盆腔肿物及阴道出血等症状或体征，尤其是在患者接受激素替代治疗的情况下。在评估女性肠道或肠系膜肿瘤时，即使患者既往接受过全腹子宫切除术及双侧输卵管卵巢切除术，特别是如果患者有子宫内膜异位症病史并接受过激素替代治疗，认识到子宫内膜异位症发生肿瘤的可能性很重要。
