Unusual Case of a Sigmoid Mass
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REVIEW ARTICLE
Unusual Case of a Sigmoid Mass Caris Grimes & Olatunde Lalude
Published online: 4 December 2009 # Humana Press Inc. 2009
Abstract Background Endometrial carcinoma is a relatively common condition which may occur with more than 6,400 new cases diagnosed each year in the UK (Cancer Research UK Statistics http://info.cancerresearchuk.org/cancerstats/types/uterus). It may occur following hysterectomy especially if associated with prolonged hormone replacement therapy. Case We report the case of a 63-year-old lady who presented with a tumour in the sigmoid mesentery 13 years after hysterectomy and following 10 years of tamoxifen therapy for a breast carcinoma. This is the first time that endometrial cancer has been reported as a complication of tamoxifen therapy in the absence of a uterus. Conclusion We suggest that endometrial carcinoma remains a differential diagnosis of any pelvic or abdominal mass even after hysterectomy, and a history of intake of oestrogen agonists and antagonists needs to be obtained. Keywords tamoxifen . endometrial carcinoma . sigmoid colon . pelvic mass
Introduction Colorectal cancer is one of the three most common cancers diagnosed in the West. Sigmoid tumours may present with constipation, nausea and abdominal bloating, as well as left-sided abdominal pain. They may also present with per rectal bleeding, weight and appetite loss. A strong family C. Grimes (*) : O. Lalude Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex CM20 1QX, UK e-mail: [email protected]
history is a significant factor. In the absence of a uterus and ovaries, a pelvic sigmoid mass with such symptoms may be thought of as most probably arising from the sigmoid colon. Breast cancer is also one of the three most common cancers in women in the West. Early breast cancers which are oestrogen-receptor positive may be treated with the antioestrogen, tamoxifen, as an adjuvant to surgery. Tamoxifen has now also been approved by the Food and Drug Administration (FDA) for prevention of breast cancer in high-risk patients. It has both agonist and antagonist effects, depending on the tissue. Tamoxifen is known to be associated with changes in the endometrium, including endometrial hyperplasia, polyps, carcinoma and uterine sarcoma [1], and can cause three to four times increased risk of endometrial cancer in women taking it for more than 4 years [2]. A recent paper shows that for women taking tamoxifen, the most common lesions found at hysteroscopy were endometrial polyps and atrophic endometrium. All endometrial polyps were oestrogen-receptor positive [3] and thus sensitive to tamoxifen. We present a case of a lady who was found to have an endometrial carcinoma attached to the sigmoid. As she had previously undergone a hysterectomy, the working diagnosis of a possible sigmoid carcinoma was maintained until histology results were available.
Case Report In April, 2007, a 63-year-old lady presented with colicky left iliac fossa and a constant left loin ache. She was nauseous but had not vomite
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