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Presented by Ralph Hruban, M.D. and prepared by Jeffrey T. Schowinsky, M.D.
Case 4: This fifty some year old woman with a history of colon cancer presented with abdominal pain and indigestion.
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1. Question
Week 269: Case 4
This fifty some year old woman with a history of colon cancer presented with abdominal pain and indigestion.images/41706RH4a.jpg
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images/41706RH4e.jpgCorrect
Answer: Infiltrating adenocarcinoma of the colon involving endometriosis
Histology: In the muscularis propria of this colon there are two distinct population of cells. One is composed of relatively mature glandular epithelium surrounded by endometrial stroma. The second is composed of markedly atypical glands with luminal necrosis. In some areas these glands appear to fuse.
Discussion: Endometriosis can mimic a variety of glandular neoplasms. The finding of glands where they not normally found can often lead to the mistaken diagnosis of an infiltrating adenocarcinoma. The presence of characteristic associated endometrial stroma, and in some instances, hemorrhage with hemosiderin-laden macrophages helps establish the diagnosis. This case is remarkable because both endometriosis and an infiltrating adenocarcinoma of the colon were present. In some areas the neoplastic glands appear to fuse/merge imperceptively with the non-neoplastic glands. The possibility of a neoplasm arising de novo from endometriosis should be considered. In this case, the patient had a known history of infiltrating adenocarcinoma of the colon.
Incorrect
Answer: Infiltrating adenocarcinoma of the colon involving endometriosis
Histology: In the muscularis propria of this colon there are two distinct population of cells. One is composed of relatively mature glandular epithelium surrounded by endometrial stroma. The second is composed of markedly atypical glands with luminal necrosis. In some areas these glands appear to fuse.
Discussion: Endometriosis can mimic a variety of glandular neoplasms. The finding of glands where they not normally found can often lead to the mistaken diagnosis of an infiltrating adenocarcinoma. The presence of characteristic associated endometrial stroma, and in some instances, hemorrhage with hemosiderin-laden macrophages helps establish the diagnosis. This case is remarkable because both endometriosis and an infiltrating adenocarcinoma of the colon were present. In some areas the neoplastic glands appear to fuse/merge imperceptively with the non-neoplastic glands. The possibility of a neoplasm arising de novo from endometriosis should be considered. In this case, the patient had a known history of infiltrating adenocarcinoma of the colon.
