Tajiri Takuya, Mima Kosuke, Kanemitsu Kosuke, Takematsu Toru, Kosumi Keisuke, Inoue Mitsuhiro, Mizumoto Takao, Kubota Tatsuo, Muto Reiji, Murayama Toshihiko, Miyanari Nobutomo, Baba Hideo
Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, 860-0008 Japan.
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556 Japan.
Int Cancer Conf J. 2021 Jul 14;10(4):294-299. doi: 10.1007/s13691-021-00493-z. eCollection 2021 Oct.
Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor of the uterus that accounts for 7-25% of uterine sarcomas and < 1% of uterine tumors. Previously reported sites include the ovary, bowel wall, abdomen, peritoneum, pelvis, and vagina; however, ESS in the extrauterine area is rare. We report a rare case of endometrial stromal sarcoma that developed in the sigmoid colon along the gonadal vasculature, which was difficult to distinguish from colon cancer. A large polyp was found in the sigmoid colon of a 74-year-old woman during a routine medical examination and was diagnosed as tubular adenoma. On colonoscopy 7 months later, the tumor had grown and blocked the lumen, causing stenosis. She was referred to our hospital for surgery. Although detailed examination at our hospital did not yield a definitive diagnosis, bowel obstruction was considered likely and we performed laparoscopic low anterior resection under a preoperative diagnosis of sigmoid colon cancer. The tumor protruded into the sigmoid colon from the stump of the ovarian arteries and veins outside the intestinal tract. As the left ovarian artery and vein were involved in the tumor, we extracted them as a lump. The tumor was diagnosed as low-grade ESS (LG-ESS). She had a history of hysterectomy and left salpingo-oophorectomy for uterine myoma 25 years ago, and radiation therapy was performed after surgery for an unknown reason. The postoperative course was uneventful, and follow-up was continued at the request of the patient. We report a rare case of ESS infiltrating the sigmoid colon, which was probably a lesion derived from endometriosis of the ovarian arteriovenous stump remaining after surgery 25 years ago.
子宫内膜间质肉瘤（ESS）是一种罕见的子宫间叶肿瘤，占子宫肉瘤的7%-25%，占子宫肿瘤的比例小于1%。先前报道的发病部位包括卵巢、肠壁、腹部、腹膜、骨盆和阴道；然而，子宫外区域的ESS较为罕见。我们报告一例罕见的子宫内膜间质肉瘤，该肿瘤沿性腺血管在乙状结肠发生，难以与结肠癌区分。一名74岁女性在常规体检时，乙状结肠发现一个大息肉，被诊断为管状腺瘤。7个月后结肠镜检查时，肿瘤增大并阻塞管腔，导致狭窄。她因手术被转诊至我院。尽管我院详细检查未能明确诊断，但考虑可能存在肠梗阻，我们在术前诊断为乙状结肠癌的情况下进行了腹腔镜低位前切除术。肿瘤从肠道外卵巢动静脉残端向乙状结肠突出。由于左卵巢动静脉受累于肿瘤，我们将其作为一个肿块一并切除。肿瘤被诊断为低级别ESS（LG-ESS）。她25年前因子宫肌瘤行子宫切除术和左侧输卵管卵巢切除术，术后曾因不明原因接受放疗。术后病程顺利，应患者要求继续随访。我们报告一例罕见的ESS浸润乙状结肠病例，可能是25年前手术后残留的卵巢动静脉残端子宫内膜异位所致病变。
