DIFFICULTY IN DIFFERENTIAL DIAGNOSIS BETWEEN GYNECOLOGICAL AND PROCTOLOGICAL TUMORS – CASE SERIES

Case Presentations Case 1: Female, 75 years old, reports abdominal pain and changes in bowel habits. Colonoscopy showed an ulcerative-infiltrative lesion 22 cm from the anal verge, histopathology indicating poorly differentiated squamous cell carcinoma (SCC). Staging cT3N2M0. The patient developed a subintestinal obstruction and was indicated for loop transverse colostomy. Abdominal MRI suggested the primary neoplasia originated in the sigmoid. The patient underwent exploratory laparotomy and left oophorectomy due to peritoneal carcinomatosis. The diagnosis of high-grade papillary serous ovarian carcinoma was confirmed by immunohistochemistry. The patient is currently undergoing chemotherapy and scheduled for cytoreductive surgery by gynecology. Case 2: Female, 28 years old, presents with abdominal pain. Colonoscopy showed a vegetative lesion 8 cm from the anal verge. Abdominal and pelvic CT and MRI revealed a tumor in the left adnexal region, rectum, and sigmoid, cT4bN2bM1a. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, segmental enterectomy, mechanical latero-lateral anastomosis, sigmoidectomy, terminal colostomy, left ureter resection, and resection of tumor implants in the sacral region. Colonoscopy histopathology showed no evidence of the primary site. The patient was referred to oncology and died 2 months after diagnosis. Case 3: Female, 73 years old, with abdominal pain, enterorrhagia, and weight loss. Colonoscopy showed a lesion 13 cm from the anal verge. Abdominal and pelvic CT showed a lesion in the uterine area in contact with the rectum and secondary involvement. Rectal biopsy confirmed invasive ulcerated colorectal carcinoma. The patient is under follow-up with gynecology and oncology.

Discussion Complex pelvic lesions in women can originate from various anatomical structures and have a broad range of possible diagnoses. Most of these masses are of ovarian origin, and MRI is useful for diagnostic differentiation. When colorectal tumors are suspected, immunohistochemistry is required. Colorectal SCC is rare (0.025-0.1 per 1,000 colon cancers), its clinicopathological characteristics are unclear, and its prognosis may be worse than that of adenocarcinoma.

Conclusion Differential diagnosis of pelvic masses is necessary for appropriate patient treatment. Early detection is crucial for favorable prognosis. Three cases initially suspected of coloproctological neoplasms were presented, where the complexity of the advanced lesions hindered diagnosis. However, after investigation, the cases were confirmed to be gynecological tumors.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025