{"id":233,"title":"Diagnostic challenge in distinguishing intestinal endometriosis-associated carcinoma from primary colorectal adenocarcinoma: a case report","title_zh":"肠道子宫内膜异位症相关癌与原发性结直肠腺癌鉴别诊断的病例报告","url":"https://pubmed.ncbi.nlm.nih.gov/42984604","doi":"10.1093/jscr/rjag991","pmid":"42984604","journal":"J Surg Case Rep","kind":"paper","lang":"en","published_at":"2026-11-04T00:00:00+00:00","fetched_at":"2026-11-08T03:44:00+00:00","authors":["Tojo N","Kataoka H","Izumi Y","Tarumi Y","Mori T"],"primary_topic":"endometrium","topics":[{"slug":"endometrium","score":5.0,"hits":["endometriosis","uterine"]},{"slug":"oocyte","score":1.0,"hits":["ovarian"]}],"topic_score":5.0,"preference_score":0.0,"preference_labels":[],"llm_score":55.0,"final_score":55.0,"score_dims":{"novelty":45,"rigor":35,"impact":40,"relevance":45,"translation":40},"recommend_reason":"单例病例报告，但对子宫内膜异位症恶变的鉴别诊断有临床提示意义：提示对疑似结直肠腺癌的育龄女性应保留苗勒管起源的可能，必要时行ER/PAX8/CK7/CK20/CDX2免疫组化复核；证据等级低，与ART核心流程关系间接。","keywords":["肠道子宫内膜异位症","恶变","结直肠腺癌","免疫组化","鉴别诊断","病例报告"],"selected":0,"story_id":87,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-uterus-pregnancy","source_name":"PubMed · 内膜/植入/早孕","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"本文报告一例43岁女性，有卵巢子宫内膜异位症病史，因黑便就诊，直肠乙状结肠肿瘤伴子宫侵犯及多发淋巴结转移。初次组织病理为中度分化腺癌，伴肠道子宫内膜异位症，但未见子宫内膜异位与癌之间的明确移行，故初诊为原发性结直肠腺癌。5年后阴道残端复发灶活检示腺癌ER、PAX8、CK7阳性，CK20、CDX2阴性；对原发肿瘤回顾性免疫组化显示相似表型，支持苗勒管起源及肠道子宫内膜异位症恶变。作者指出仅凭形态学判断肿瘤起源存在困难，免疫组化具重要诊断价值。","summary":"Malignant transformation of intestinal endometriosis is rare and may closely mimic primary colorectal adenocarcinoma. A 43-year-old woman with a history of ovarian endometriosis presented with melena and a rectosigmoid tumor with uterine invasion and multiple lymph node metastases. Histopathological examination revealed moderately differentiated adenocarcinoma with intestinal endometriosis but no definitive transition between the endometriosis and the carcinoma, supporting an initial diagnosis of primary colorectal adenocarcinoma. Five years later, biopsy of a recurrent vaginal stump lesion showed an adenocarcinoma positive for estrogen receptor, paired box gene 8, and cytokeratin 7 and negative for cytokeratin 20 and caudal-type homeobox transcription factor 2. Retrospective immunohistochemical evaluation of the original tumor demonstrated a similar phenotype, supporting a Müllerian origin and malignant transformation of intestinal endometriosis. This case illustrates the difficulty of determining tumor origin based on morphology alone and highlights the diagnostic value of immunohistochemistry.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}