Department of Pathology, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
Int J Gynecol Pathol. 2024 Nov 1;43(6):605-611. doi: 10.1097/PGP.0000000000001019. Epub 2024 Jul 29.
The rectovaginal septum is an unusual location for neoplastic processes. The majority of these are extensions of tumors of the rectum or vagina. Masses arising primarily from the rectovaginal fascia are rare. Most primary rectovaginal malignant neoplasms are carcinomas that arise in the setting of endometriosis. Sarcomas in this location are exceedingly rare, with only few cases reported in the literature. We report a case of a 44-year-old lady who developed a high-grade sarcoma in the rectovaginal septum in the setting of endometriosis. We also discussed the differential diagnosis of this lady's challenging and unique lesion, which is most probably an extra-uterine "uterine-type" high-grade sarcoma that shows overlapping features of several entities. Moreover, we performed a literature review of sarcomas in this rare location. Given the fact that the rectovaginal septum is a common location for endometriosis, in the case of a rectovaginal neoplasm, a thorough sampling and a careful search for endometriotic lesions are important, as they may be a clue for the diagnosis. Although rare, sarcomas should always be considered in the differential diagnosis of rectovaginal neoplasms.
阴道直肠隔是发生肿瘤的不常见部位。这些肿瘤大多数是直肠或阴道肿瘤的延伸。主要来源于阴道直肠筋膜的肿块很少见。大多数原发性阴道直肠恶性肿瘤是子宫内膜异位症背景下发生的癌。该部位的肉瘤非常罕见，文献中仅报道了少数几例。我们报告了一例 44 岁女性，在子宫内膜异位症背景下，阴道直肠隔发生高级别肉瘤。我们还讨论了这位女性具有挑战性和独特病变的鉴别诊断，该病变极有可能是一种宫外“子宫型”高级别肉瘤，具有几个实体的重叠特征。此外，我们对该罕见部位的肉瘤进行了文献复习。鉴于阴道直肠隔是子宫内膜异位症的常见部位，对于阴道直肠肿瘤，彻底取样和仔细寻找子宫内膜异位症病变很重要，因为它们可能是诊断的线索。尽管罕见，但肉瘤在阴道直肠肿瘤的鉴别诊断中应始终被考虑。
