基于子宫内膜异位的直肠-乙状结肠透明细胞癌合并子宫内膜样腺癌:病例报告

The rectal-sigmoid colon clear cell carcinoma mixed with endometrial adenocarcinoma based on endometriosis:A case report

报告1例基于子宫内膜异位的直肠-乙状结肠透明细胞癌合并子宫内膜样腺癌,并对病例特点及治疗进行分析。患者,女,66岁,因腹胀10 d为主诉于本院就诊,临床表现为右下腹肿块,无明显压痛,肛查无明显异常。影像学检查:盆腔右侧-乙状结肠右旁见不规则软组织肿块影,病灶左侧缘与乙状结肠分界不清,致肠腔偏心性狭窄;阴道残端上方见形状不规则肿块,病灶与肠管分界不清。患者20年前因双侧卵巢子宫内膜异位行全子宫切除术+右侧附件切除术+左侧卵巢囊肿剔除术。此次手术切除直肠与乙状结肠肿物与右侧髂窝肿物,病理显示子宫内膜样腺癌与透明细胞癌混合。术后化疗:力朴素240 mg/卡铂500 mg。化疗期间肿瘤复发且进行性增大,肿瘤标记物持续增加,换用多美素50 mg后依旧持续性进展。子宫内膜异位至肠道并恶变病例罕见,且本例对化疗耐受,与卵巢癌变相同的治疗方法是否值得推广有待进一步探究。

This article reports a case of rectal-Sigmoid colon clear cell carcinoma with endometrial adenocarcinoma based on endometriosis and analyzes its features and treatment.The female patient,aged 66 years,attended our hospital with the chief complaint of abdominal distension for 10 days,and clinical manifestation included a mass in the right lower abdomen,with no obvious tenderness or abnormalities in anal examination.Imaging examination showed an irregular soft tissue mass on the right side of the pelvic cavity,located at the right side of the sigmoid colon,with unclear boundaries between the left side of the lesion and the sigmoid colon,which led to the eccentric stenosis of the intestinal cavity,and irregular masses were observed above the vaginal stump,with unclear boundaries between the lesion and the intestinal canal.The patient underwent total hysterectomy+right adnexectomy+left ovarian cyst removal due to ovarian endometriosis at both sides 20 years ago.The masses in the rectum,the sigmoid colon,and the right iliac fossa were surgically removed,and pathological examination showed endometrial adenocarcinoma with clear cell carcinoma.Lipusu 240 mg and carboplatin 500 mg were given as postoperative chemotherapy.Recurrence and progressive enlargement of tumor were observed during chemotherapy,with continuous increases in tumor markers,and progression was still observed after the drug was switched to Domesil 50 mg.The case of endometriosis involving the intestine with malignant transformation is rare,and this case is resistant to chemotherapy.Further studies are needed to explore the promotion of the same treatment method as ovarian cancer.