Clinical stage IB endometrial adenocarcinoma with an isolated small bowel metastasis

Although patients with widely disseminated endometrial adenocarcinoma can have tumor involving the intestine, a focal metastasis to the small bowel with no other evidence of extra-uterine spread has not been reported. A patient with a clinical stage IB, grade 2 superficially invasive endometrial adenocarcinoma was found to have an isolated distant metastasis to the small intestine. The patient has been asymptomatic and disease free for almost 4 years following postoperative treatment with whole abdominal radiation therapy on a Gynecologic Oncology Group protocol. The finding of a solitary small bowel metastasis was not predictable based on the current understanding of the biologic behavior of endometrial adenocarcinomas. This case emphasizes the need for a thorough abdominal exploration in patients with endometrial adenocarcinoma by surgeons trained to detect and resect abdominopelvic tumors, and it validates the need for innovative treatment protocols for women with gynecologic malignancies.