Rectal Adenocarcinoma Presenting as a Cervical Mass: A Case Report

Objective: Background: Case Report: Conclusions: Challenging differential diagnosis Invasive cervical tumors are often seen in clinical practice. However, there are multiple structures within the pelvis, and invasion of the cervix from another site must be included in the differential diagnosis. In such cas-es, a multidisciplinary approach is needed to define the organ of tumor origin. Ensuring proper staging and histologic analysis are critical for optimal management. We present a case of a 68-year-old woman who presented to her gynecologist with painless post-menopaus-al vaginal bleeding. She was diagnosed with a locally aggressive cervical adenocarcinoma, which was histolog-ically confirmed by an in-office biopsy. She was referred to the gynecologic oncology service at a tertiary care hospital for definitive management, where a thorough clinical workup was performed. Physical exam revealed that the mass had invaded the anterior rectal wall. Through a multidisciplinary approach and a repeat biop-sy, she was correctly diagnosed with an invasive rectal adenocarcinoma. She was treated with neoadjuvant chemoradiotherapy and underwent curative surgery. Had she been incorrectly treated as having a primary cervical adenocarcinoma, there would have been no role for surgery. The change in the organ of primary drasti-cally altered the patient’s management and outcome. She is currently undergoing surveillance with cross-sec-tional imaging. Cervical masses originating from non-gynecologic organs can be difficult to differentiate on physical exam and histologic analysis. When a mass involves the rectum, an invasive primary rectal adenocarcinoma must be included in the differential. This will have a significant impact on patient management and ultimately on patient survival.