Adenosquamous carcinoma of the colon presenting with hypercalcemia

Clinicopathological and molecular characteristics of colorectal adenosquamous carcinoma in an Asian population

BACKGROUND

Adenosquamous carcinoma is a rare sub-type of colorectal cancer with a poor prognosis. Little is known about its clinicopathological and molecular characteristics in Asian populations. This study aimed to investigate these features in a cohort of patients with adenosquamous carcinoma in the colorectum.

METHODS

Tumor cases pathologically diagnosed with colorectal adenosquamous carcinoma were retrieved from the Sixth Affiliated Hospital, Sun Yat-sen University tissue archive between December 2012 and June 2020. Clinicopathological features, molecular characteristics, and oncology outcomes were analyzed.

RESULTS

Among 18,139 cases of colorectal cancer, 11 were diagnosed with adenosquamous carcinoma, providing an incidence rate of 0.061%. The median overall survival (OS) was 14 months, and the expected 3-year OS rate was 29.6%. As of October 14, 2022, four cases had local recurrence and five had distant metastasis. KRAS gene mutations were found in four of seven patients (57.1%), and three out of eleven (27.3%) patients had mismatch repair-deficient (dMMR) tumors.

CONCLUSIONS

Adenosquamous carcinoma is associated with a poor prognosis. Compared to other sub-types of colorectal cancer, a higher proportion of patients with dMMR and KRAS mutations were observed. These findings suggested that more patients with adenosquamous carcinoma could benefit from targeted therapies, such as immunotherapy.

Adenosquamous Carcinoma of the Colon. Case Report of an Unusual Type

Primary adenosquamous carcinoma of the colon is a rare entity. Its prevalent site of origin is at the level of the proximal portion of the large bowel. The tumor presents in young patients and follows a highly aggressive course. We present an extremely unusual case of adenosquamous carcinoma in which the classical mucinous and signet-ring cell adenocarcinoma was associated with the squamous component. The prognosis of this rare neoplasm is very poor.

Hypercalcemia of Malignancy and Colorectal Cancer

Our aim is to describe the association between colorectal cancer (CRC) and humoral hypercalcemia of malignancy (HHM). Causes of hypercalcemia of malignancy include parathyroid hormone-related peptide (PTHrP) secretion, local osteolysis, calcitriol production and ectopic parathyroid hormone (PTH) secretion. Hypercalcemia of malignancy in patients with CRCs is a rare scenario. A patient with anal squamous cell carcinoma was admitted with hypercalcemia, suppressed PTH and hypophosphatemia. He was found to have metastatic anal squamous cell carcinoma to the liver. Further evaluation revealed elevated PTHrP and 1,25-dihydroxyvitamin D and low 25-hydroxyvitamin D. Over a 5-month course, the hypercalcemia responded poorly to bisphosphonates, transiently to prednisone, but showed marked improvement with chemotherapy. A review of English language publications in Pubmed and a reference search of retrieved articles revealed 29 cases of CRC causing PTHrP-mediated hypercalcemia. Most patients were middle-aged men (mean ± SD: 56.7 ± 13.4 years), with advanced metastatic cancer (85% with hepatic metastasis) and severe hypercalcemia (mean ± SD: 15.6 ± 1.9 mg/dL, 62% with Ca > 14). This condition is associated with high mortality (79%) and short survival (median 54.5 days, CI: 21 - 168). Despite being uncommon, HHM (PTHrP-mediated) should be considered in patients with metastatic CRC presenting with hypercalcemia. Clinicians should be aware that combined etiologies may be present, particularly in cases of resistant hypercalcemia. Treatment of the underlying malignancy is essential for calcium control.

Basaloid Squamous Cell Carcinoma of the Sigmoid Colon

Basaloid squamous cell carcinoma (BSCC) of the colon is rarely found proximal to the anal canal. We report a case of an 81-year-old woman who was diagnosed with squamous cell carcinoma (SCC) of the lung without metastasis and BSCC of the sigmoid with differing histologic findings suggesting that these tumors were separate primary neoplasms. SCC of the colon has a dismal prognosis. Surgery is the primary method of treatment when feasible, in addition to chemotherapeutic agents.

Adenosquamous carcinoma of the ascending colon: a case report and review of the literature

An adenosquamous carcinoma is a malignancy that has both glandular and squamous histologic components. Both components are malignant and have potential to metastasize. An adenosquamous carcinoma of the large bowel is rare, and its clinicopathologic behavior is not fully understood. It is reported to be more aggressive and have a worse prognosis when it is compared with an adenocarcinoma alone. We present a case of an adenosquamous carcinoma in the ascending colon which was laparoscopically resected and followed by adjuvant chemotherapy.

[Colorectal epidermoid carcinoma and paraneoplastic hypercalcemia]

The squamous cell carcinoma and the adenosquamous cell carcinoma of the colon and rectum are not well know and rare tumours. We report a case of squamous cell carcinoma of the recto-sigmoid who relapses in the liver after surgery of the primary tumour with paraneoplasic hypercalcaemia. We will discuss the pathogenesis, prognosis, associated conditions, clinical features and treatment strategies of squamous and adenosquamous cell carcinoma of the colon and the rectum.

Adenosquamous Carcinoma of the Colon: A Rare Tumor

Adenosquamous carcinoma of the colon is rare. A paraneoplastic syndrome presenting as hypercalcemia may occasionally occur in association with these tumors. Survival for more advanced stages of disease is lower than for patients with adenocarcinoma at a corresponding stage. We report a patient who presented with a primary adenosquamous carcinoma of the rectosigmoid junction and we review the literature regarding the clinical presentation, management, and prognosis of this tumor.

Humoral hypercalcemia complicating adenocarcinoma of the sigmoid colon: report of a case

Humoral hypercalcemia can arise from a variety of malignancies, but its association with primary colorectal carcinoma is rare, with only 20 such cases documented in the English-language literature to date. We report an additional case to clarify the clinicopathologic features of colorectal carcinoma with humoral hypercalcemia. A 54-year-old woman was admitted with symptomatic hypercalcemia of 14.2 mg/dl and multiple hepatic metastases, 2 years after resection of sigmoid colon cancer. The hypercalcemia was caused by the circulating parathyroid hormone-related peptide (PTHrP) produced by poorly differentiated adenocarcinoma in the liver. The PTHrP level on admission was 13.5 pmol/l. Despite systemic chemotherapy, the patient died of disease progression 3 weeks after the humoral hypercalcemia was diagnosed. A review of the 21 reported cases, including ours, suggests that colorectal carcinoma associated with humoral hypercalcemia is characterized by a poorly differentiated tumor with or without squamous or neuroendocrine features, distant metastases, and a dismal prognosis.

Paraneoplastic Hypercalcemia in a Patient with Adenosquamous Cancer of the Colon

Hypercalcemia is a well-known manifestation of paraneoplastic syndromes associated with a variety of malignancies. However, colon cancer has only rarely been associated with hypercalcemia of malignancy. We present the case of a patient with recurrent adenosquamous carcinoma of the ascending colon found to have hypercalcemia. The patient is a 76-year-old white woman who initially presented with colon cancer in the cecum and underwent a right hemicolectomy. All lymph nodes and surgical margins were free of tumor. Pathological examination at that time revealed adenosquamous carcinoma of the colon. Eight months later she complained of dizziness, anorexia, and constipation and was found to have a calcium level of 13.6 mg/dL. CT scan revealed a mass measuring 10.5 to 12.7 cm in the right hepatic lobe, and a bone scan was normal. Her intact parathyroid hormone (PTH) level was 6 pg/mL (normal 12–72) and her PTH-related protein (PTHrP) level was 25.7 pmol/L (normal <1.3). She then underwent a hepatic resection. The serum PTH, calcium, and PTHrP levels normalized after resection. Hypercalcemia of malignancy in colon cancer is rare and has an association with adenosquamous histology. The hypercalcemia is attributed to PTHrP, and here we demonstrate this in the serum and tumor specimens. The effects of PTHrP are shown to be short-lived postoperatively. We find only 14 other cases in the literature of hypercalcemia related to a colonic neoplasm, and this is the only patient reported to be surviving. The diagnosis of a paraneoplastic syndrome mediated via PTHrP should be considered when hypercalcemia is encountered in the setting of metastatic colon carcinoma.

Primary adenosquamous carcinoma of the rectum. Report of 4 cases and review of the literature

OBJECTIVE

To review the experience of two referral centres in the management of an infrequent condition: primary adenosquamous carcinoma of the rectum, a rare disease.

MATERIALS AND METHODS

Four cases of primary adenosquamous carcinomas of the rectum are reported with a review of the literature. No preoperative diagnosis of adenosquamous carcinoma was established. All tumours were located in the rectum. Two patients presented with liver metastasis. No preoperative therapies were indicated. All patients underwent surgery.

RESULTS

Patients underwent anterior resections (n=2), recto-sigmoid resection (n=1) and abdomino-perineal excision (n=1). All resected specimens had positive lymph nodes and metastatic liver disease was confirmed in the two cases. No adjuvant therapy was carried out after surgery and patients died within 8 months after surgical treatment.

CONCLUSIONS

Adenosquamous carcinoma of the rectum is a rare and aggressive tumour characterized by coexisting of malignant glandular and squamous components. Presentation is usually at an advanced stage. The tumour is aggressive and metastatic disease at the time of diagnosis is common. Surgery is the treatment of choice. Adjuvant therapy is difficult to evaluate prospectively due to the rarity of the condition. Survival is less than 50% than that for adenocarcinoma.

Adenosquamous carcinoma of the small intestine. Report of a case and review of the literature

Primary adenosquamous carcinomas of the intestine are rare tumors, particularly those occurring in the small bowel. We report the third case of an adenosquamous carcinoma of the ileum in a 55-year-old-man. Histologically, the tumor consisted of malignant glandular and squamous elements. A review of the literature is presented.

Adenosquamous carcinoma of the colon, rectum, and anus: epidemiology, distribution, and survival characteristics

PURPOSE

There have been 49 cases of adenosquamous carcinoma of the colon, rectum, and anus reported in the English literature. We have reviewed 145 cases of adenosquamous carcinoma to better define epidemiologic and survival characteristics of this extremely rare colon carcinoma.

METHODS

The National Cancer Institute's Surveillance, Epidemiology, and End Results program public use CD-ROM file for the years 1973 through 1992 were reviewed. This represents approximately 9.5 percent of the United States population. Adenosquamous carcinomas arising in the colon, rectum, and anus were identified using the International Classification of Diseases-O codes. The Astler-Coller tumor classification was used for staging. Two-tailed Student's t-test, Mantel-Haenszel chi-squared tests, and generalized Wilcoxon's tests were used for comparisons of means, proportions, and actuarial survival rates, respectively. Survival curves were calculated by the Kaplan-Meier method.

RESULTS

One hundred forty-five cases of adenosquamous carcinoma were identified, representing 0.06 percent of all colorectal malignancies. The mean age of patients was 67 years. Eighty-four percent of patients were Caucasians, 15 percent were Afro-Americans, and 1 percent were other races. Afro-Americans were diagnosed at a significantly younger age (median age, 62 years; P = 0.03). Fifty-three percent of the carcinomas were located in the sigmoid colon, rectum, and anus, 28 percent in the right colon, and the rest in the middle segment. Seventy-four percent of distal cases were staged A through C, compared with 44 percent of proximal cases. Patients with adenosquamous carcinoma of the sigmoid colon, rectum, and anus survived longer than all other patients (P = 0.001). Patients with adenosquamous carcinoma Stages A and B1 had survival rates similar to patients with comparably staged adenocarcinomas. Fifty percent of the patients, including most of the patients with D stage, died in the first year. Patients with Stages B2, C, and D adenosquamous carcinomas had a significantly shorter survival than the comparably staged adenocarcinomas (P < or = 0.02). The overall adjusted five-year survival rate was 30.7 percent. In those patients who survived more than 24 months, the five-year survival was 84 percent.

CONCLUSIONS

The survival rates for patients with adenosquamous carcinoma Stages A and B1 are similar to patients with comparably staged colorectal adenocarcinomas. However, we found that patients with colorectal and anal adenosquamous carcinomas staged B2 through D have significantly poorer survival than patients with comparably staged adenocarcinomas, supporting the previous reports of a poor prognosis associated with adenosquamous carcinomas.

Adenosquamous carcinoma of the colon and rectum

PURPOSE

Adenosquamous carcinomas of the colon and rectum are rare tumors. These tumors have malignant glandular and squamous components capable of metastasizing. We report seven patients with adenosquamous carcinoma of the colon and rectum and their clinical outcomes.

METHODS

Retrospective review was undertaken of seven patients who were identified by the tumor registry at Roswell Park Cancer Institute between 1971 and 1994.

RESULTS

These represent a 0.18 percent incidence of adenocarcinomas in our institution. There were five tumors located in the rectum and two in the colon. All patients were Stage III or IV on presentation. Median overall survival was 23 months. In three patients, the tumor was associated with ulcerative colitis; in one of these patients, hypercalcemia was present. All patients died of their disease or with the disease.

CONCLUSIONS

Previously reported aggressive behavior of this cancer is confirmed in our series.

Cloacogenic anal carcinoma presenting with humoral hypercalcemia: report of a case

We present herein the case of a 60-year-old man found to have a rare type of cloacogenic anal carcinoma. The disease was advanced and aggressive with local invasion to the prostate as well as distant lymph node metastases to the neck and paraaortic region on presentation. Therefore, a palliative abdominoperineal resection was performed, 10 weeks following which the patient developed humoral hypercalcemia. Despite treatment with hydration, furosemide, steroids, and calcitonin, serum calcium continued to rise and the patient died on the 95th postoperative day. Laboratory findings revealed a decreased parathyroid hormone (PTH) level and marked elevation of parathyroid hormone-related protein (PTHRP). The detection of the PTHRP in the tumor extract and the positive immunohistochemical staining for this in the tumor cells suggested that the humoral hypercalcemia was definitely caused by its associated tumor production. Although hypercalcemia is not an uncommon complication of solid cancers in their late stage, only three other cases of rectal cancer with hypercalcemia have ever been reported. To our knowledge, this is the first documentation of cloacogenic anal carcinoma accompanied by PTHRP-induced severe humoral hypercalcemia.

Adenosquamous carcinoma of the duodenum. An immunohistochemical study

A rare adenosquamous carcinoma of the duodenum occurred in an 84-year-old woman. Histologically the neoplasm showed evidence of glandular and squamous differentiation, and both components showed malignant characteristics. Intermediate elements sharing squamous and glandular features, were found and were immunoreactive for carcinoembryonic antigen, epithelial membrane antigen and cytokeratins of both low and high molecular weight. A review of the literature and discussion about the histogenesis is included.

Effect of dietary vitamin D3 (cholecalciferol) on colon carcinogenesis induced by 1,2-dimethylhydrazine in male Fischer 344 rats

This study examined the effect of increasing dietary vitamin D on chemically induced colon carcinogenesis. Male Fischer 344 rats were first injected with 1,2-dimethylhydrazine (200 mg/kg) and then fed one of five dietary levels of vitamin D as cholecalciferol (250, 1,000, 2,000, 4,000, and 10,000 IU/kg diet) for nine months. Dietary vitamin D3 had no effect on weight gain. Plasma 25-hydroxyvitamin D3 levels were similar for the 1,000 and 2,000 IU/kg groups but varied in a dose-related manner for the other groups. Vitamin D did not significantly alter the tumor incidence in either the distal or the proximal colon. No significant differences in the labeling index were found in either the proximal or the distal colon. Within the distal colon, the proliferative zone increased in a dose-related manner. Distribution of labeled cells within the crypt compartments was not affected by dietary vitamin D. Bone and serum minerals in general were unaffected by dietary vitamin D. This study shows that, at this level of dietary calcium, vitamin D did not affect 1,2-dimethylhydrazine-induced colon carcinogenesis.