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Case Reports in Surgery
Volume 2015, Article ID 256838, 4 pages
http://dx.doi.org/10.1155/2015/256838
Case Report

Unusual Presentation of Recurrent Early Stage Endometrial Carcinoma 28 Years after Primary Surgery

14th General Surgery Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, 10126 Turin, Italy
22nd Phathological Anatomy Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, 10126 Turin, Italy

Received 15 May 2015; Revised 18 October 2015; Accepted 22 October 2015

Academic Editor: Frédéric Marchal

Copyright © 2015 Alessandro Franchello et al. This 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.

Abstract

Endometrial carcinoma is the most common neoplasia of female genital tract. The prognosis of early stage disease (FIGO I and FIGO II) is excellent: recurrence after surgery is less than 15%, most of which are reported within 3 years after primary treatment. Herein we report a case of late rectal recurrence from FIGO Ib endometrial adenocarcinoma. Patient had also familiar and personal history of colonic adenocarcinoma and previous findings of microsatellite instability (MSI); molecular analysis evidenced heterozygotic somatic mutation in MLH1 gene. Twenty-eight years after hysterectomy and bilateral salpingoovariectomy, a rectal wall mass was detected during routine colonoscopy. Patients underwent CT scan, pelvic MRI, and rectal EUS with FNA: histopathological and immunohistochemical analysis revealed differentiated carcinoma cells of endometrial origin. No neoadjuvant treatment was planned and low rectal anterior resection with protective colostomy was performed; histology confirmed rectal lesion as metastasis from endometrial carcinoma. Recurrence of early stage endometrial carcinoma after a long period from primary surgery is possible. It is important to keep in mind this possibility in order to set a correct diagnostic and therapeutic algorithm, including preoperative immunohistochemical staining, and to plan a prolonged follow-up program.