A perforated sigmoid colon cancer initially diagnosed as a tubo‐ovarian abscess: A teaching case

Delayed metastatic endometrial carcinoma mimicking primary colon adenocarcinoma: A surprise histopathological finding

Key Clinical Message

Colorectal cancer is the third most common malignancy worldwide, with an increasing incidence. Colonic metastasis is a rare occurrence; thus, misdiagnosis is common. Immunohistochemistry facilitates accurate diagnosis and subsequent management.

Abstract

Most cancers in the colon are primary colorectal cancers, however metastasis from another primary is possible, albeit rare. Endometrial cancer metastasis to the colon is a rare occurrence and is only described in a handful of cases. We describe a rare case of metastatic endometrial cancer in the colon presenting 5 years post radical hysterectomy and adjuvant radiotherapy in a 62-year-old female. She presented with a 1-week history of right upper quadrant pain, with no other associated symptoms. She was presumed to have a primary colorectal cancer based on her colonoscopy and CT findings; later proven otherwise by immunohistochemistry (IHC). Endometrial cancer metastasis to the colon is rare, thus misdiagnosis can easily occur. Currently, there are 6 similar cases reported in the literature, all occurring in the absence of colorectal endometriosis. This case illustrates the relative importance of considering colon as a potential site for metastasis of endometrial cancer and the utility of IHC in aiding diagnosis and guiding further management.

A case of periodic abdominal pain and fever due to left ovarian abscess

Tubo-ovarian abscess (TOA) is a late complication of pelvic inflammatory disease. Its diagnosis is difficult because it is occasionally accompanied by atypical symptoms such as abdominal pain and fever. A 45-year-old married woman presented with recurrent abdominal pain and fever. Her medical history included ovarian surgery 14 years prior to presentation. Computed tomography (CT) performed by her local doctor confirmed uterine fibroids and a left ovarian tumor. Following a detailed examination and magnetic resonance imaging at our hospital, a TOA was suspected, and surgery was planned. During surgery, the adhesion was firm and required laparotomy. Ultimately, the left ovarian tumor was confirmed to be a TOA. Although complete surgical resection was not feasible. A surgical drain was inserted, and the pus was drained. Cultures revealed Citrobacter freundii and other organisms, and oral quinolone antibiotics were administered. CT performed on the fourth postoperative day demonstrated a residual abscess; however, 5 weeks after surgery, CT showed complete resolution of the residual abscess. Subsequently, the antibiotic regimen was terminated, and progestins were administered for the treatment of endometriosis, which is still ongoing.