# A case report of recurrent endometrial cancer invading the rectum and bladder with concurrent primary rectal cancer treated with total neoadjuvant therapy and pelvic exenteration

## TL;DR

A rare case of endometrial cancer invading the rectum and bladder, along with a primary rectal cancer, was successfully treated with neoadjuvant therapy and pelvic exenteration.

## Contribution

This case report highlights the importance of multidisciplinary discussion and immunohistochemical testing in diagnosing complex cancer cases.

## Key findings

- Endometrial cancer was confirmed as the primary culprit in the rectum, bladder, and vaginal cuff.
- Early suspicion and additional testing could prevent misdiagnosis in similar cases.
- Total neoadjuvant therapy and pelvic exenteration led to successful treatment outcomes.

## Abstract

Endometrial cancer, the fourth most common cancer affecting women in the USA, typically recurs locally or can invade regional lymph nodes and the peritoneum. A 66-year-old female with history of Stage 1b endometrial adenocarcinoma was found to have rectal adenocarcinoma on surveillance colonoscopy. Cross-sectional imaging demonstrated a vaginal cuff mass with bladder wall thickening and unilateral hydronephrosis. A bladder mass was identified and partially resected on cystoscopy; pathology was indicative of urothelial carcinoma. The final surgical specimen demonstrated endometrial cancer as the primary culprit in all three organs, confirmed by additional immunohistochemical staining of the previous bladder resection specimen. The rarity of hollow organ involvement in locoregional endometrial cancer recurrence can engender misdiagnosis, potentially leading to discordant treatment and suboptimal outcomes. A high index of suspicion in conjunction with multidisciplinary discussion may have prompted additional immunohistochemical testing to obtain the correct diagnosis earlier in the patient’s clinical course.