P1333 - “Go Deep!” Hail Mary Biopsy With Beguiling Colonoscopy Finding

Muhammad Khan, MD, MPH¹, Mitchel Hoffman, MD², Jeffrey Aufman, MD¹, Meir Mizrahi, MD^3
1HCA Healthcare/USF Morsani College of Medicine GME/Largo Medical Center, Largo, FL; ²University of South Florida Moffitt Cancer Center, Tampa, FL; ³Florida Digestive Health Specialists, Largo, FL

Introduction: Mullerian carcinoma arising in the colon without gynecologic origin or typical colorectal symptom is very rarely reported1,2. Origin of these tumors is not well understood, and a secondary Mullerian system has been suggested3.

Case Description/Methods: A 70 yo female presented with Barrett’s Esophagus. She denied dysphagia, heartburn, abdominal/pelvic pain, change in bowel habits, weight loss, or rectal bleeding. Her medical history included Barrett’s Esophagus diagnosed 4 years prior; benign tubular adenoma of the colon diagnosed 3 years prior; and total hysterectomy with bilateral salpingo-oopherectomy (THBSO) 2 years prior for vaginal bleeding and suspected endometrial cancer, with ultimate negative histopathology. Family history was notable for first-degree family members with colorectal cancer. Physical examination was unremarkable except for class 1 obesity. Esophagogastroduodenoscopy (EGD) and colonoscopy were pursued.



EGD showed an irregular Z-line; endomicroscopy showed Barrett’s esophagus with intestinal dysplasia. Histopathology and histocytology of biopsies showed Barrett’s esophagus without dysplasia.



Colonoscopy showed few tiny scattered sessile polyps of the rectum, with histopathology showing hyperplasia, as well as irregular mucosa of the sigmoid colon characterized by edema and distortion. Histopathology of biopsies showed Mullerian carcinoma in the deeper mucosa, which was positive for CK7 immunohistochemistry.

Discussion: The unexpected finding of primary mixed Mullerian tumor in the sigmoid colon of this asymptomatic woman who had undergone previous THBSO has been very rarely reported. Of the few reported cases, most were associated with endometriosis or symptoms of colon cancer. Despite the rarity of this colonic tumor, it was deep tissue acquisition during biopsy which was critical in this cancer diagnosis.




1 Yang Q, Wang H, Cho HY, Jung SJ, Kim KR, Ro JY, Shen SS. Carcinoma of müllerian origin presenting as colorectal cancer: a clinicopathologic study of 13 Cases. Ann Diagn Pathol. 2011 Feb;15(1):12-8.



2 Slavin RE, Krum R, Van Dinh T. Endometriosis-associated intestinal tumors: a clinical and pathological study of 6 cases with a review of the literature. Hum Pathol. 2000 Apr;31(4):456-63.



3 Evans H, Yates WA, Palmer WE, Cartwright RL, Antemann RW. Clear cell carcinoma of the sigmoid mesocolon: a tumor of the secondary müllerian system. Am J Obstet Gynecol. 1990 Jan;162(1):161-3.


Figure: Irregular mucosa of the sigmoid colon; biopsies showed Mullerian carcinoma of the deeper mucosa.


Disclosures:
Muhammad Khan indicated no relevant financial relationships.
Mitchel Hoffman indicated no relevant financial relationships.
Jeffrey Aufman indicated no relevant financial relationships.
Meir Mizrahi indicated no relevant financial relationships.


Muhammad Khan, MD, MPH¹, Mitchel Hoffman, MD², Jeffrey Aufman, MD¹, Meir Mizrahi, MD³. P1333 - “Go Deep!” Hail Mary Biopsy With Beguiling Colonoscopy Finding, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.