Summary
Endometrial cancer is the third most common gynaecologic malignancy in India and is an important cause of postmenopausal bleeding. Hereditary predisposition as well as simultaneous occurrence of colon cancer and endometrial cancer have been studied and reported. Thus, any patient of diagnosed colon cancer presenting with abnormal/postmenopausal vaginal bleeding should be carefully investigated. This is a case of carcinoma ascending colon who presented with postmenopausal bleeding and careful workup could detect the endometrial pathology at preinvasive stage i.e endometrial intraepithelial neoplasia.
Keywords: Endometrial carcinoma, Carcinoma colon, vaginal bleeding, salpingoopherectomy

Introduction
Endometrial cancer is the most common gynaecologic malignancy in developed world and third most common gynaecologic malignancy in developing countries like India. A very peculiar presentation of endometrial cancer is with postmenopausal bleeding which is seen in 90% of patients as a presenting symptom.1 Endometrial cancer accounts for etiology of postmenopausal b l e e d i n g i n 1 5 % o f p a t i e n t s . 2 H e r e d i t a r y predisposition to colorectal cancer and a wide range of other malignancies (e.g., endometrial, ovarian, and gastric cancer) has been studied over years. Also, simultaneous occurrence of endometrial cancer with colorectal cancer has been reported in literature.3 Thus, if a patient of colorectal cancer presents with abnormal vaginal bleeding, strict vigilance can help detect endometrial cancer at early/preinvasive stage.
We hereby represent a case of carcinoma ascending colon with endometrial intraepithelial neoplasia.

Case Report
A 40-year-old female, moderately built who was illiterate and a labourer by occupation presented in the outpatient department of our hospital, the Gujarat Cancer and Research Institute, Ahmedabad in February 2019 with complaints of postmenopausal bleeding from last 15days. She had attained menopause 3 years back. She was a diagnosed case of poorly differentiated adenocarcinoma of ascending colon. She had undergone exploratory laparotomy with right hemicolectomy with ileotransverse
anastomosis with double barrel stomy at a government hospital, Ahmedabad in 2016. She was then referred to our hospital for adjuvant treatment and had received 8 cycles of Capecitabine. After remaining disease free for 1 year, stoma closure surgery was done in 2017 at the same place of initial surgery. She did not have any medical comorbidity. She was a habituated tobacco chewer for 10 years. There was no significant history of cancers running in the family.

Further on evaluating the cause of postmenopausal bleeding, on ultrasonography, she was found to have 18mm thickened endometrium. Endometrial aspiration showed complex hyperplasia without atypia. Endometrial biopsy was performed which favored precursor lesion naming endometrial intraepithelial neoplasia. A preoperative computed tomography of thorax, abdomen and pelvis was performed which did not show disease elsewhere. Bilateral mammography was normal.

Patient was planned for staging laparotomy and before posting her, a clearance for surgical o n c o l o g i s t w a s s o u g h t t o l o o k f o r a n y recurrence/residual disease as well as need of any biopsy intraoperatively. A preoperative colonoscopy was advised which was normal. She was then posted for surgery with plan of intraoperative gross examination as well as frozen section examination of uterus. Peritoneal cytology was taken and total a b d o m i n a l h y s t e r e c t o m y w i t h b i l a t e r a l salpingoophorectomy, bilateral pelvic lymph node dissection and omental sampling were performed. Uterus was cut open in OT as planned which showed thick and irregular endometrium. Frozen report demonstrated superficial Endometrial tumor/Neoplasia. No myometrial invasion was seen.

Peritoneal cytology came out to be negative for malignant cells. Final histopathology confirmed the endometrial intraepithelial neoplasia/endometrial carcinoma in situ (focally) without stromal invasion. Endometrial thickness was 1.5 cm, myometrium, cervix and both ovaries were unremarkable. Both fallopian tubes had normal histology. Omentum and bilateral pelvic lymph nodes were free of any tumor.