A strange case of rectum hemorrhage

A 62-year-old woman with a medical history of hysteroannessiectomy due to endometriosis went to Emergency Department for recurrent hematochezia. A colonoscopy showed a large submucosal nodule covered by normal mucosa in the distal-medium rectum and a second smaller nodule covered by ulcerated mucosa in the proximal rectum. Biopsies were performed. Endoscopic Ultrasound (EUS) revealed in the posterior pelvis a 5-6 cm solid hyperechoic mass, with hypoechoic spots compressing distal rectal. Histological evaluation of biopsies was suggestive of endometrial adenocarcinoma. Magnetic resonance imaging and computed tomography scans confirmed the rectal lesions and showed multiple subcentimetric rectal and abdominal lymph nodes. The patient underwent neoadjuvant chemotherapy followed by surgery. Intestinal en-dometriotic deposits are found in between 8-12% of women with endometriosis and only few cases report a neoplastic transformation. The initial treatment for endometrial cancer is surgery, however neoadjuvant chemotherapy followed by surgery seems effective in cases of neoplastic intraperitoneal diffusion.