case_images: PMC11750269_01
case_images: PMC11750269_02
case_images: CT abdomen/pelvis with IV contrast. Fibroid appearing uterus with two distinct enhancing masses, both approximately 3 cm and separate from the endometrial cavity. Arrow pointing at mass of interest. (a) axial view. (b) coronal view, (c) sagittal.
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case_images: CT abdomen and pelvis revealed a fibroid uterus with two distinct masses, one at the right lateral margin of the uterus and another at the left lateral margin that abutted the sigmoid colon measuring 3 cm (Fig. 1).
case_images: CT abdomen/pelvis, 4 years after initial presentation. Arrow pointing at the mass of interest that now measures 4 cm in size (previously 3 cm). Appearance now concerning for primary colonic neoplasm as it is contiguous with the colon. (a) axial, (b) coronal, (c) sagittal.
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case_images: ROMA score of 26.5%. Repeat CT imaging revealed an enlarging pelvic mass now involving the sigmoid colon (Fig. 2).
case_images: Rectum biopsy showed haphazardly arranged columnar cell proliferation (A) demonstrating bland cytological features (B). The colon biopsy (C, D) showed invasive adenocarcinoma with pseudostratified columnar cells in the neoplastic glands, mimicking invasive colorectal adenocarcinoma. Tumor cells were positive for CK7, ER and PAX8 and negative for CK20 and CDX2, ruling out colorectal adenocarcinoma and consistent with endometrioid adenocarcinoma. Final rectosigmoid pathology revealed endometriosis and atypical endometrial hyperplasia on the serosal surface (E, F), with transition to endometrioid adenocarcinoma. Both glandular and solid patterns were observed in the muscular layer of the colon (G). The mucosal aspect of colon showed mainly granulation tissue mixed with scant endometrioid adenocarcinoma (H).
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case_images: See Fig. 3.