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Endometrial cancer metastatic to the transverse colon mimicking colorectal cancer

Published:January 09, 2023DOI:https://doi.org/10.1016/j.amjms.2023.01.001
      A 68-year-old woman presented with a month history of formless stool. She had received hysterectomy for endometrial cancer 2 years ago. The level of cancer antigen 125 was elevated (46.77 U/mL; normal level, 0–35 U/mL). Other tumor markers were normal, including alpha fetoprotein, carcinoembryonic antigen and cancer antigen 199. Colonoscopy (Fig. 1A) showed a 50% circumferential extent tumor with superficial ulcer in the transverse colon, 60 cm from the anus. Abdominal contrast enhanced CT (Fig. 1B) demonstrated an oval mass involving the anterior wall of the transverse colon (red arrow), approximately 2.4 cm in diameter. A ring-like enhanced oval mass was also revealed in the right paracolic gutter (yellow arrow), approximately 3.2 cm in diameter. No other lesion was found, including the liver and lymph nodes. Photomicrograph of a colonoscopic biopsy of the mass in the transverse colon indicated metastatic endometrioid adenocarcinoma (Fig. 1C: the tumor containing cribriform structure with gland fusion), with the following immunohistochemistry results: Vimentin (+) (Fig. 1D), CDX-2 (-) (Fig. 1E), CK7 (+) (Fig. 1F), P16 (+) (Fig. 1G), CK20 (-), PR (-).
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