A 57-year-old woman who had undergone hysterectomy in another center in 2003 with double adnexectomy for pelvic endometriosis and uterine myomatosis. She also had a large 20 cm cyst in the right ovary that broke during the second surgery.
In 2008, she consulted for rectal bleeding of about 8 months of evolution without other associated symptoms.
The patient was admitted with an ulcerated surface area located 10 cm from the anal verge, which showed the presence of stenosis.
CT-colon was completed confirming a 4 cm long rectal stenosing neoplasm with absence of perirectal fat and lymphadenopathy.
Endoanal ultrasound for local staging of the lesion attributed a type T3N1.
There was no evidence of metastatic extension.
The pathology report was poorly differentiated adenocarcinoma.
The patient was referred to our hospital with a neoadjuvant treatment regimen consisting of capecitabine 825 mg/m2 and radiation therapy over the pelvis with a dose of 180 cG0.4y/week, 5
After reevaluation, a partial radiological response was observed, with a T2-3N0 lesion.
Laparotomic malignancy of the upper third of the rectum, multiple lymph nodes and inferior adenomegaly adherence were decided.
Low anterior resection was performed with Quirke grade 2 mesorectal excision.
Postoperative complications included prolonged paralytic ileus and urinary fistula due to left ureter, which required double J drainage, with good evolution.
The anatomopathological report of the surgical piece revealed an unusual rectal wall due to a poorly differentiated adenocarcinoma with abundant signs of the piece and bodies of poma, of extradigestive origin, probably gynecological.
The immunohistochemical profile showed negativity for cytokeratin CK 20 and positivity for CK 7, as well as discreet positivity for estrogen receptors.
The patient received adjuvant chemotherapy with taxol-adriamycin-CDDP x 6 cycles.
There was no clinical or radiological evidence of relapse in subsequent 6-year follow-up.
