We report the case of a 47-year-old woman with a 10-year history of uterine myoma and bilateral salpinguectomy for endometriosis.
It was studied by abdominal pain located in the lower hemiabdomen, as well as hematochezia and diarrhea accompanied by weight loss of one month of evolution.
Physical examination showed a good general appearance, and rectal examination showed the presence of a friable mass with bleeding on the cheek.
Hematological examination showed hemoglobin at the lower limit of normal.
A diagnosis was made where an excrecent and mamelnated lesion of tumoral aspect that extended the light was identified at 8 cm of anal margin.
The pathology of the biopsies taken showed the presence of rectal mucosa caused by an epidermoid carcinoma.
Immunohistochemistry of the samples showed positivity for CK7 and negativity for CK20 with overexpression of P16.
HPV 16 was detected by median PCR technique.
No pathological findings were identified in cervical cytology and uterine curettage biopsies.
In the computerized axial tomography (CAT) an irregularity was observed in the middle rectum as well as adenopathies in the mesorectal fat of pathological aspect and others of smaller size and nonspecific periaortic.
Magnetic resonance imaging showed a voicing mass of 8 cm in length in the middle third of the rectum with distinctive features CRM + mesorectal fat and vaginal fornix without cleavage plane (T4).
The case was discussed in the rectal tumor committee of our center, and it was decided to perform neoadjuvant treatment with cisplatin and radiotherapy.
After 4 months of treatment in the reassessment tests a poor response to treatment was observed and surgical intervention was planned.
Posterior exenteration was performed with pelvic peritonitis and intraoperative radiotherapy.
In the definitive pathological analysis, a moderately differentiated squamous cell carcinoma of the rectum was evident with involvement of the radial margin pT3N1 with immunohistochemical positivity for AE1, AE3, CK7 and overexpression of p16 and p63.
The patient recovered well during the immediate postoperative period and subsequently received adjuvant treatment with cisplatin and fluouracil.
At 9 months of treatment it was evidenced by regional recurrence imaging tests that has been treated with chemotherapy to date with little response.
The current follow-up is 24 months.
