Squamous-cell carcinoma of the colon responsive to combination chemotherapy: report of two cases and review of the literature

An Unusual Tumor: Squamous Cell Carcinoma of the Colon in Lynch Syndrome

Primary squamous cell carcinoma of the colon and rectum is a rare malignancy. Most of the anatomical sites that are reported to be affected include the esophagus and anal canal. This report highlights the case of a 54-year-old male with a known history of Lynch syndrome and a previous diagnosis of colon cancer who was found to have a recurrence of malignancy affecting this unlikely area. The treatment strategies for this colorectal squamous cell carcinoma have not been thoroughly explored, so this report aims to highlight effective interventions, including surgical resection and neoadjuvant chemotherapy and radiation. There is a poor prognosis associated with this condition, as it does not typically present until the late stages; however, in this particular instance, early detection leads to improved outcomes.

Squamous cell carcinoma of the colon: evaluation of treatment modalities and survival

BACKGROUND

Squamous cell carcinoma of the colon (CSCC) is a rare subtype of colon cancer. This study aimed to evaluate treatment strategies and overall survival (OS).

METHODS

Using the Surveillance, Epidemiology, and End Results program database from 2008 to 2019, patients aged 18 years with CSCC were identified. Treatment strategies and OS were summarized using the Kaplan-Meier analysis and the log-rank test. Adjusted Cox proportional hazards regression model ratios were calculated to evaluate the effect of confounding variables.

RESULTS

After exclusions, 153 patients met the inclusion criteria. The most common treatment modalities included surgery alone (52.1%), surgery and adjuvant chemotherapy (12.9%), and no treatment (26.4%). Kaplan-Meier analysis revealed that patients who underwent surgery and adjuvant chemotherapy had significant improvements in OS (log-rank P = .002). Cox regression analysis revealed tumor grade (hazard ratio [HR], 2.12; 95% CI, 1.17-3.86) and receipt of chemotherapy (HR, 2.66; 95% CI, 1.23-5.76) as the only factors associated with improvements in OS.

CONCLUSION

Patients who underwent surgery in combination with chemotherapy had better OS than those who underwent surgery alone. Tumor grade and receipt of chemotherapy were independently associated with OS.

Primary Squamous Cell Carcinoma of the Cecum: A Case Report

Primary squamous cell carcinoma (SCC) of the colon is an exceptionally rare diagnosis. The etiology and pathogenesis of this entity remain unclear. It usually presents in patients as an emergency, typically with the tumor in the advanced stage. We report a case of SCC of the cecum presenting with perforation, initially diagnosed as SCC of unknown origin. The patient underwent a limited right hemicolectomy and end ileostomy outside our center. The patient was referred to us for further workup and possible adjuvant chemotherapy. She was assessed clinically and found to have had poor appetite and anorexia for a month, with an intermittent fever documented at 39 degrees. Thus, the patient was elected to get admitted for a septic workup and re-staging by CT scan and tumor biomarkers. CT showed a phlegmon and abscess formation at the right iliac fossa that was attached to surrounding structures, including the abdominal wall. Drain placement at the site of the phlegmon was attempted but failed due to bowel overlapping. Therefore, the patient was booked for surgical exploration and drainage, where all structures were resected en bloc. Histopathological examination revealed well-differentiated keratinized SCC with lymph node metastasis. The diagnosis of primary SCC of the cecum was confirmed after investigations to rule out primary sources were negative. Surgical resection remains the mainstay of management, with a possible role for chemotherapy and radiation therapy. The prognosis in these cases is usually poor. This warrants early diagnosis and management. Studies are needed to establish a management protocol for this entity.

Squamous cell carcinoma of ascending colon with pMMR/MSS showed a partial response to PD-1 blockade combined with chemotherapy: A case report

Primary colon squamous cell carcinoma (SCC) is extremely rare and associated with a poor prognosis. Moreover, there is no treatment guideline for this disease. Proficient mismatch repair/microsatellite-stable (pMMR/MSS) colorectal adenocarcinoma is refractory to immune monotherapy. Although the combination of immunotherapy with chemotherapy in pMMR/MSS colorectal cancer (CRC) is currently under investigation, the clinical activity of this approach in colorectal SCC remains unknown. In this article, we report the case of a pMMR/MSS CRC patient with ascending colon SCC who had high programmed cell death–ligand 1 (PD-L1) expression and the a missense mutation in codon 600 of the B-Raf proto-oncogene (BRAF V600E) mutation. The patient exhibited a significant response to the combination of immunotherapy and chemotherapy. After eight cycles of treatment with the combination of sintilimab and mFOLFOX6 (oxaliplatin, fluorouracil, and leucovorin), computed tomography–guided microwave ablation of the liver metastasis was performed. The patient achieved excellent durable response and continues to experience a good quality of life. The present case indicates that programmed cell death 1 blockade combined with chemotherapy may be an effective therapy for patients with pMMR/MSS colon SCC and high PD-L1 expression. Furthermore, PD-L1 expression may be a biomarker for immunotherapy in patients with colorectal SCC.

A primary squamous cell carcinoma of the sigmoid colon in a young patient: A case report and literature review

Colon cancer is among the most common types of cancer with adenocarcinomas being the most common type. Herein we report a young patient who presented with primary colonic squamous cell carcinoma without risk factors. To the best of our knowledge, this is the youngest patient with such diagnosis worldwide.

Primary sigmoid squamous cell carcinoma with liver metastasis: A case report

BACKGROUND

The pathological type of simple squamous carcinoma in colorectal malignancies is rare. Simple squamous cell carcinoma of the colorectum occurs most frequently in the rectum. The clinicopathological features and biological behaviors of squamous colorectal carcinoma are unclear, and its prognosis may be worse than that of simple adenocarcinoma. Studies on squamous colorectal cancer are currently limited to case reports, and there is no standard treatment protocol. Therefore, more case reports are required to fully understand squamous colorectal cancer.

CASE SUMMARY

We reported the case of a 56-year-old woman who complained of constipation for 2 years. Colonoscopy revealed a sigmoid colon tumor, and the pathological result of colonoscopy was squamous carcinoma. After completing the relevant assessment, the patient was clinically diagnosed with cT4aN0M0, stage IIB, and surgery was performed. Based on postoperative pathological results, the patient was diagnosed with pT4bN0M0, stage IIC. Six cycles of adjuvant chemotherapy were administered after surgery. Liver metastasis and abdominal wall mass were found more than 1 mo after the end of the last chemotherapy session. Targeted local treatment was not performed because the liver had multiple metastases, but I¹²⁵ particle implantation of the abdominal wall mass was performed. Two cycles of first-line chemotherapy were administered after the surgery. The patient underwent 14 mo of treatment and eventually died from the tumor.

CONCLUSION

Squamous carcinoma of sigmoid colon is a rare tumor with unclear pathogenesis. Its clinicopathological diagnosis should be paid close attention.

Mixed neuroendocrine-non-neuroendocrine neoplasm with squamous cell carcinoma covered by tubulovillous adenoma in the rectum

A variety of histologies is often mixed in neuroendocrine carcinoma (NEC) called mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN). However, tumors consisting of both large-cell NEC and squamous cell carcinoma (SCC) are rare. NEC of the large intestine is aggressive; however, an ideal treatment strategy has not been established. In this study, we have reported a case of rectal MiNEN containing large-cell NEC and SCC that was covered by tubulovillous adenoma. A 73-year-old man was referred to our hospital for the treatment of an upper rectal tumor. The results of preoperative biopsy indicated tubulovillous adenoma, whereas computed tomography revealed multiple liver tumors and swollen lymph nodes around the rectum. Laparotomy was performed because of severe dyschezia caused by rectal stenosis. Hartmann's operation was performed because of peritoneal metastases. Histopathological examination of the rectal tumor revealed MiNEN containing large-cell NEC, SCC, well-differentiated adenocarcinoma, and tubulovillous adenoma covering the surface of the tumor. The patient died 73 days after surgery due to liver metastases. It is important to consider NEC in the differential diagnosis and tissue sampling should be performed to ensure appropriate management when pathological findings and clinical diagnosis do not match. More research is required to determine the ideal treatment for these rare and aggressive tumors.

Metastatic squamous cell carcinoma of the colon: a conundrum in colorectal malignancies

Small-cell carcinoma of the colon is an extremely rare tumour, with poorly understood pathogenesis and unestablished treatment guidelines. The first case was documented in 1919, and only about 100 cases of this condition have been reported to this date. In this case report, we present a case of sigmoid squamous cell carcinoma that eventually led to bowel perforation and was diagnosed on histopathology after emergent surgical intervention. Additionally, we also review the incidence, epidemiology, pathogenesis, immunohistological markers, neogenomics and therapeutic strategies for the same.

Primary colonic squamous cell carcinoma: a case report and review of the literature

Colonic squamous cell carcinoma is extremely rare, with no clear pathogenesis. It usually presents as an emergency. We present the surgical management of a descending colon squamous cell carcinoma, together with a review of the available cases of colonic squamous cell carcinoma in the literature. A 69-year-old woman presented with a palpable mass and abdominal pain. She underwent ultrasound and colonoscopy, which revealed a large obstructing mass at the descending colon, the biopsies of which were not diagnostic. Unfortunately, she was readmitted with bowel obstruction and underwent extended right hemicolectomy with en-bloc excision of attached small bowel and omentum because of local mass expansion. Histopathological analysis demonstrated squamous cell carcinoma with lymph node metastases. Palliative chemotherapy followed, owing to liver and peritoneal deposits. Sixty-six cases of colonic squamous cell carcinoma have been reported in the literature. The most common location is the right colon. Most cases present at a late stage. Several theories for the pathogenesis of colonic squamous cell carcinoma have been reported; the most popular is the squamous transformation of a pluripotent stem cell.

Primary Squamous Cell Carcinoma of Colon and Rectum: A Systematic Review of the Literature

Background - Objective: Primary colorectal squamous cell carcinoma is an extremely rare neoplasm with an incidence of 0.1 to 0.25 per 1,000 diagnosed colorectal carcinomas.The objective of this study was to evaluate its biological behavior and highlight the role of a surgical approach for its management.Methods: PubMed and Cohrane databases were independently searched (last search: April 10th, 2020) for articles concerning colorectal squamous cell carcinoma in adult population.Results: Seventy-one studies met predefined inclusion criteria and involved 99 patients (54.5% females) with an age of 56.98 ± 12.19 years (mean ± SD). The most frequent site of occurrence was the rectum (63.5%). Open surgery was conducted at 95% of patients, while 21.4% and 30.3% received neoadjuvant and adjuvant therapy respectively.Postoperative complications were developed in 31.3% of patients, while 6.1% died withing the first month following operation. Five-years survival rate was 49.5% (95% CI: 33.7%-63.4%). Female sex (HR: 0.24; 95% CI: 0.11-0.54; p-value: 0.001) and presence of postoperative complications (HR: 4.10; 95%CI: 1.47-1.46; p-value: 0.007) significantly affected the survival.Conclusions: Colorectal Squamous Cell Carcinoma is a rare tumor with an aggressive behavior. Surgery is the standard of treatment for the colontumors, while the role of chemoradiotherapy is promising especially for rectal tumors. Further clinical trials are necessary to determine the preferred treatment approach.

Primary Squamous Cell Carcinoma of the Descending Colon

Primary squamous cell carcinoma (SCC) of the colon is a rare malignancy. The most reported anatomic location is the rectosigmoid colon. In this paper, we report a case of a 74-year-old man with primary SCC of the descending colon treated by surgery and adjuvant chemotherapy. We diagnosed primary SCC of the descending colon because except in the colon, no malignant lesions were found by systemic CT. The role of chemoradiation regimen and duration remains unclear due to the rarity of this entity.

Diagnostically challenging human papillomavirus-associated primary squamous cell carcinoma of the rectum with metastasis in both ovaries: a case report

Introduction

Squamous cell carcinomas of the rectum are extremely rare and their pathogenesis is still under debate. Their proper diagnosis and treatment may thus be challenging.

Case presentation

A 52-year-old Caucasian woman was transferred to our department with a history of pelvic pain. Colonoscopy revealed a small tumorous lesion of the upper rectum and an endoscopic biopsy showed infiltration of the rectal mucosa by a squamous cell carcinoma. Afterward, tumorous lesions were found on imaging in both her ovaries. A laparoscopy with adnexectomy and anal mapping was performed and revealed tumor masses of squamous cell carcinoma in both ovaries. Based on the large size of the ovarian tumors and the concurrence of extensive, partly ciliated, macrocystic epithelium in one of the ovaries, a diagnosis of ovarian squamous cell carcinoma arising from a mature teratoma was rendered. However, human papillomavirus genotyping analyses were positive for human papillomavirus-16 in both the rectal tumor and ovarian tumors leading to a final diagnosis of a human papillomavirus-associated rectal squamous cell carcinoma metastatic to both ovaries. Neoadjuvant chemoradiation therapy of her rectum, total mesorectal excision, and hysterectomy were performed followed by adjuvant chemotherapy.

Conclusion

Colorectal squamous cell carcinoma is a rare disease. In cases of colorectal squamous cell carcinoma, metastatic disease at any other location has to be excluded. Human papillomavirus genotyping is essential in this context. Discussion of the treatment strategies should be interdisciplinary and include chemoradiation therapy and radical surgery.

Mixed neuroendocrine and squamous cell carcinoma of the colon: A case report and literature review

INTRODUCTION

The occurrence of Neuroendocrine Carcinoma (NEC) of the colon is <2% of all colon cancers. Squamous Cell Carcinoma (SCC) is even more unusual and has an occurrence in the colon as low as 0.1% of colon cancers. Coupled together mixed NEC-SCC, is nearly unheard of. SCC of the gastrointestinal tract is usually found in the esophagus and rectum, rarely are there squamous cells even present in the colon.

PRESENTATION OF CASE

A 62-year-old female presented with abdominal pain and a palpable mass in the left lower quadrant. CT scan revealed a poly-lobulated mass in the left abdomen attached to the left colon. A left hemicolectomy was performed. There were no distant metastases at the time of diagnosis. Microscopic examination revealed NEC mixed with SCC demonstrated by keratin pearl formation.

DISCUSSION

NEC and SCC individually are unusual in the colon but together are extraordinarily rare. Histologically, the NEC in this case demonstrated squamous cell differentiation with keratin pearl formation. The median survival in studies of patients with colonic NEC is 5-10 months due to the aggressive behavior and lymph node metastases, which were present in this case. There is insufficient literature addressing ideal adjuvant therapy after resection of mixed NEC and SCC of the colon.

CONCLUSION

We present the first case of primary colon mixed NEC and SCC which presented as abdominal pain. There is a current absence of ideal therapy recommendations in the medical literature following resection of mixed NEC and SCC of the colon.

Definitive Chemoradiation for Squamous Cell Carcinoma of the Rectum

OBJECTIVES

Squamous cell carcinoma (SCC) of the rectum is a rare disease with <80 cases reported in the English literature. We reviewed outcomes in patients with SCC of the rectum treated with definitive chemoradiation at a single institution.

MATERIALS AND METHODS

We identified 14 patients treated definitively with chemoradiation for SCC of the rectum. All patients were female and the median age was 56 years at presentation. Patients were treated with external beam radiation therapy with a median dose of 54 Gy (range, 38 to 58.8 Gy). All patients received concurrent chemotherapy, with 5-flourouracil and cisplatin in 10 patients and capecitabine and cisplatin in 4 patients.

RESULTS

The median follow-up was 4.5 years (range, 1.8 to 16.3 y). Only 3 of the 14 patients had relapse or persistent disease, and 2 of these underwent successful salvage surgery. The remaining 11 patients had no evidence for local or distant relapse after chemoradiation. Only 1 patient died of SCC of the rectum, 1 died of a second primary, and 12 are alive with no evidence of disease. The 5-year actuarial overall survival, disease-free survival, and disease-specific survival rates were 81%, 72%, and 88% respectively.

CONCLUSIONS

Chemoradiation is an ideal strategy for definitive therapy of SCC of the rectum with excellent disease-free survival and overall survival. In patients with local failure, salvage surgery can provide excellent outcomes.

Squamous cell carcinoma of the ascending colon: two cases

Squamous cell carcinoma (SCC) of the colon without known primary source is a rare finding that needs aggressive management. We report two cases of SCC of the colon without any clear extra-colonic source despite extensive workup. In our experience, the clinical course and prognosis are largely dependent on the presence of metastatic disease at diagnosis. The main treatment is surgery, with chemotherapy having less defined role.

Complete pathologic response after chemoradiotherapy in a patient with rectal squamous cell carcinoma: a case report

Squamous cell carcinoma (SCC) of the rectum is a rare disease. A 59-year-old man presented with SCC of the middle rectum located 10 cm from the anus. The stage of the tumor was revealed to be T3N+M0. The patient received a combined treatment with cisplatin and fluorouracil in concomitance with external radiation therapy. He then underwent an anterior resection of the rectum. The postoperative histopathological findings classified the tumor as ypT0N0 with cancer-free margins and lymph nodes. Treatment of SCC remains very challenging, and the acquisition of more consistent data is needed.

Rectal squamous cell carcinoma in immunosuppressed populations: is this a distinct entity from anal cancer?

OBJECTIVE

Squamous cell carcinoma (SCC) of the rectum is rare, but as with anal cancer, risk may be increased among immunosuppressed individuals. We assessed risk of rectal SCC in HIV-infected people.

DESIGN

Population-based registry.

METHODS

We utilized the HIV/AIDS Cancer Match, a linkage of US HIV and cancer registries (1991-2010), to ascertain cases of anal SCC, rectal SCC, rectal non-SCC, and colon non-SCC. We compared risk in HIV-infected persons with the general population using standardized incidence ratios (SIRs) and evaluated risk factors using Poisson regression. We reviewed cancer registry case notes to confirm site and histology for a subset of cases.

RESULTS

HIV-infected persons had an excess risk of rectal SCC compared with the general population (SIR = 28.9; 95% CI 23.2-35.6), similar to the increase for anal SCC (SIR = 37.3). Excess rectal SCC risk was most pronounced among HIV-infected MSM (SIR = 61.2). Risk was not elevated for rectal non-SCC (SIR = 0.88) or colon non-SCC (SIR = 0.63). Individuals diagnosed with AIDS had higher rectal SCC rates than those with HIV-only (incidence rate ratio = 1.92; 95% CI 1.08-3.42). Based on available information, one-third of rectal SCCs were determined to be misclassified anal cancer.

CONCLUSION

HIV-infected individuals, especially with advanced immunosuppression, appear to have substantially elevated risk for rectal SCC. As for anal SCC, rectal SCC risk was highest in MSM, pointing to involvement of a sexually transmitted infection such as human papillomavirus. Site misclassification was present, and detailed information on tumour location is needed to prove that rectal SCC is a distinct entity.

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.

Colorectal squamous cell carcinoma: a rare tumor with poor prognosis

PURPOSE

Primary squamous cell carcinomas of the colon and rectum are extremely rare, with an incidence of less than 1% of colorectal malignancies. Our aim in this study was to evaluate patient characteristics, treatment strategy, and postoperative follow-up of patients with colorectal squamous cell carcinoma.

METHODS

We reviewed our prospectively maintained colorectal cancer database for all patients who were diagnosed with colorectal squamous cell carcinoma between January 1990 and April 2009.

RESULTS

Out of 5149 patients with colorectal malignancy, 11 patients (0.2%) met the study criteria. Median age at the time of diagnosis was 64. Median BMI was 28 kg/m2. The tumors were localized in the rectum (n = 8), right colon (n = 2), and sigmoid colon (n = 1). The pathologic stages of these tumors were I (n = 1), II (n = 4), III (n = 3), and IV (n = 3). Operations performed were abdominoperineal resection (n = 4), right colectomy (n = 2), total colectomy (n = 1), low anterior resection (n = 1), local excision (n = 1), sigmoidectomy (n=1) and end colostomy creation (n = 1). One patient received intraoperative radiotherapy. Postoperative chemotherapy was given to eight patients, and three patients received postoperative radiation therapy. Median follow-up after diagnosis was 42 months (12-96). Three patients developed recurrence after potentially curative surgery. Five patients died from metastatic disease during follow-up.

CONCLUSION

Squamous colorectal cancer can be detected in any part of the colon, generally presents at a later stage, and is associated with a poor prognosis. Surgery is the mainstay of treatment. Various adjuvant chemoradiation treatments appear not to influence the outcome. Further cases need to be analyzed in order to find more effective treatment regimens.

Squamous cell carcinoma of middle rectum: Literature review

INTRODUCTION

Squamous cell carcinoma SCC of the rectum is a distinct entity. We report a very rare case of squamous cell carcinoma of the middle rectum.

PRESENTATION OF CASE

The patient was a 62-year-old woman who presented with a history of rectal bleeding and discomfort. Colonoscopy revealed a polypoid tumour of the middle rectum. Biopsies of this mass revealed a poorly differentiated SCC of the rectum. CT scan of the chest, abdomen and pelvis was negative for distal metastases. The patient received combined chemo-radiation followed by surgical excision. The postoperative period was uncomplicated.

DISCUSSION

The pathogenesis of rectal SCC remains unclear and diagnosis is often delayed. Diagnostic criteria have been proposed. MRI of the rectum and trans-rectal endoscopic ultrasound R-EUS provide essential information to plan a therapeutic approach. The squamous cell carcinoma antigen level is not suitable for initial diagnosis of rectal SCC. Most authors conclude that the surgery is the gold standard treatment. Tumour stage is the most important prognostic predictor of SCC.

CONCLUSION

Squamous cell carcinoma of the rectum is a distinct entity. Before the final choice of treatment is made, digestive surgeons should bear in mind this rare tumour.

Young patient age as the cause of delayed diagnosis of gastrointestinal carcinoma

Most patients diagnosed with gastrointestinal carcinomas are older people. The above-mentioned fact may lead to an erroneous finding that the problem does not concern patients aged between 20 and 30 years. Unfortunately, this assumption is often the reason for late diagnosis and delayed treatment of these malignancies. The study presented an example of three patients subject to surgical management of gastrointestinal carcinomas at the II Department of General and Gastroenterological Surgery, Medical University in Białystok.

Population-based evaluation of adenosquamous carcinoma of the colon and rectum

BACKGROUND

Information about adenosquamous carcinoma of the colon and rectum is scarce because of its extremely low incidence.

OBJECTIVE

The aim of this study was to examine the prognostic significance of a histological diagnosis of adenosquamous carcinoma in comparison with adenocarcinoma of the colon and rectum.

DESIGN

This study was retrospective in design.

SETTING

California Cancer Registry data from 1994 through 2004 with follow-up through 2008 were analyzed.

PATIENTS

Patients were included whose cancer of the colon and rectum, excluding the anus with a tumor histology of adenocarcinoma and adenosquamous carcinoma, was surgically treated.

MAIN OUTCOME MEASURES

The primary outcomes measured were histology-specific survival analyses (with the use of the Kaplan-Meier method), and overall and colorectal-specific mortality (with the use of multivariable Cox proportional hazards regression analyses).

RESULTS

A total of 111,263 adenocarcinoma and adenosquamous carcinoma of colon and rectal cancer cases were identified (adenocarcinoma, 99.91%; adenosquamous carcinoma, 0.09%). There was no significant difference in sex, age, race, and socioeconomic status between the 2 groups. The most common location of adenocarcinoma and adenosquamous carcinoma was the right and transverse colon. The adenosquamous carcinoma group was significantly associated with a higher rate of metastasis at the time of operation (adenosquamous carcinoma, 36.56% vs adenocarcinoma, 13.92%) and with poorly differentiated tumor grade (adenosquamous carcinoma, 65.96% vs adenocarcinoma, 19.74%) in comparison with the adenocarcinoma group. The median overall survival time was significantly greater in the adenocarcinoma group (82.4 months) in comparison with the adenosquamous carcinoma group (35.3 months). With the use of multivariable hazard regression analyses, adenosquamous carcinoma histology was independently associated with increased overall mortality (hazard ratio, 1.67) and colorectal-specific mortality (hazard ratio, 1.69) in comparison with adenocarcinoma.

CONCLUSIONS

This is one of the largest studies of adenosquamous carcinoma of the colon and rectum to date. This uncommon colorectal cancer subtype was associated with higher overall and colorectal-specific mortality in comparison with adenocarcinoma. Among colorectal cancer cases, adenosquamous carcinoma histology should be considered a poor prognostic feature.

Neuroendocrine and squamous colonic composite carcinoma: Case report with molecular analysis

Composite colorectal carcinomas are rare. There are a modest number of cases in the medical literature, with even fewer cases describing composite carcinoma with neuroendocrine and squamous components. There are to our knowledge no reports of composite carcinoma molecular alterations. We present a case of composite carcinoma of the splenic flexure in a 33 year-old Caucasian male to investigate the presence and prognostic significance of molecular alterations in rare colonic carcinoma subtypes. Formalin-fixed paraffin-embedded (FFPE) tissue was hematoxylin and eosin- and mucicarmine-stained according to protocol, and immuno-stained with cytokeratin (CK)7, CK20, CDX2, AE1/AE3, chromogranin-A and synaptophysin. DNA was extracted from FFPE tissues and molecular analyses were performed according to lab-developed methods, followed by capillary electrophoresis. Hematoxylin and eosin staining showed admixed neuroendocrine and keratinized squamous cells. Positive nuclear CDX2 expression confirmed intestinal derivation. CK7 and CK20 were negative. Neuroendocrine cells stained positively for synaptophysin and AE1/AE3 and negatively for chromogranin and mucicarmine. Hepatic metastases showed a similar immunohistochemical profile. Molecular analysis revealed a G13D KRAS mutation. BRAF mutational testing was negative and microsatellite instability was not detected. The patient had rapid disease progression on chemotherapy and died 60 d after presentation. Although the G13D KRAS mutation normally predicts an intermediate outcome, the aggressive tumor behavior suggests other modifying factors in rare types of colonic carcinomas.

Chemoradiotherapy in the management of primary squamous-cell carcinoma of the rectum

AIM

To assess the efficacy of chemoradiotherapy in the management of primary squamous-cell carcinoma of the rectum.

METHOD

Nine patients with primary squamous-cell carcinoma of the rectum were treated with chemoradiotherapy from 1985 to 2007. All patients were female, with a mean age of 54 years (range 41-72 years). The mean distance of the tumour from the anal verge was 6 cm (range 4-10 cm). Seven patients were treated with curative intent (two postoperative, three preoperative, two chemoradiotherapy alone). Clinical stages for the curative group were T1N0M0 (1), T3N0M0 (3), T3N1M0 (1) and T4N0M0 (2). Chemoradiotherapy consisted of pelvic radiation 45-54 Gy in 1.8 Gy/fraction and concurrent 5-fluorouracil and mitomycin C. The mean follow-up duration for the curative group was 39 months (range 15-120 months).

RESULTS

All seven patients treated with curative intent achieved local control. A complete pathological response was seen in all patients after preoperative chemoradiotherapy. Two patients did not have surgery and remained free of disease. One patient with gross residual disease after surgery achieved local control. 18-Fluorodeoxyglucose (FDG) avidity was detected in all patients who had FDG-PET scans. Both primary and metastatic tumours demonstrated FDG-avidity.

CONCLUSION

Primary squamous-cell carcinoma of the rectum appears to be very sensitive to chemoradiotherapy. The high complete response rate suggests that chemoradiotherapy alone with salvage surgery for local failure should be further explored. FDG-PET scan may have a role to play in the management of this disease.

Floor-of-mouth metastasis in colorectal cancer

Colorectal cancers have potential for lymphatic and hematogenous metastases. Surgery is the definitive treatment, but the prognosis can be improved with the addition of chemotherapy, radiotherapy or both. However, the incidence of recurrence, both local and distant, remains significant. Distant metastases occur most often in the liver and lung; however, metastases to bone, adrenals, lymph nodes, brain, skin and the oral region have been reported. Metastases to the oral region are uncommon and may occur in the oral soft tissues or jaw bones. The prognosis in such patients is usually very poor. We report a case of colorectal carcinoma with metastasis to the floor of the mouth. This is probably the first reported case of metastasis to the floor of the mouth in a patient with colorectal cancer.

Squamous cell carcinoma of rectum presenting in a man: a case report

BACKGROUND

Primary squamous cell carcinomas of the colorectum are very uncommon. Until now, to the best of our knowledge, only 114 cases of squamous cell carcinoma in the colorectum exist in the reported literature. Here we report a case of squamous cell carcinoma of the rectum in the ethnic Kashmiri population in northern India.

CASE PRESENTATION

The case of a 60-year-old male patient (Asian) with a pure squamous cell carcinoma of the rectum is presented here. The patient underwent a curative surgery with concomitant chemotherapy. Two years after the initial curative resection of the tumor he is still alive.

CONCLUSION

The prognosis for squamous cell carcinoma of the colorectum is worse than for that of adenocarcinoma, because of the delayed diagnosis. The etiopathogenicity of squamous cell carcinoma of the colorectum is discussed. Surgical resection of the lesion seems to be the treatment of choice. Chemotherapy also helps in improvement of the prognosis.

Primary Submucosal Squamous Cell Carcinoma of the Rectum Diagnosed by Endoscopic Ultrasound: Case Report and Literature Review

Primary colorectal squamous cell carcinoma (SCC) is one of the very rare malignancies of the gastrointestinal tract. The diagnosis cannot be made before ruling out other common primary sites. Using the endoscopic ultrasound (EUS) technique to get a tissue biopsy for submucosal tumors has not been demonstrated as the best diagnostic approach in the literature. Surgery is the gold standard treatment with arising evidence of good efficacy following conventional chemoradiation therapy. A 49-year-old male presented with rectal discomfort. Sigmoidoscopy revealed multiple submucosal masses in the rectosigmoid colon. Mucosal biopsies showed nonspecific inflammation. Subsequently, an EUS with fine needle biopsy was done and established the diagnosis of rectal SCC. There were no other primary sites noticed in the extensive evaluation. The patient chose to be treated only with chemoradiation without surgery. At the time of writing this report he had no evidence of recurrence achieving 2.5 years of survival. EUS is an emerging excellent approach to diagnose submucosal colorectal SCC. This case will add supportive evidence of having a complete response following combining treatment with squamous cell directed chemotherapy and external beam radiotherapy without preceded surgery.

Squamous cell cancer of the rectum

Squamous cell carcinoma of the rectum is a rare malignancy. It appears to be associated with chronic inflammatory conditions and infections. The clear association seen between Human Papilloma Virus and various squamous cancers has not been firmly established for the squamous cell cancer of the rectum. The presentation is nonspecific and patients tend to present with advanced stage disease. Diagnosis relies on endoscopic examination with biopsy of the lesion. Distinction from squamous cell cancer of the anus can be difficult, but can be facilitated by immunohistochemical staining for cytokeratins. Staging of the cancer with endoscopic ultrasound and computed tomography provides essential information on prognosis and can guide therapy. At present, surgery remains the main therapeutic option; however recent advances have made chemoradiation a valuable therapeutic addition. Squamous cell carcinoma of the rectum is a distinct entity and it is of crucial importance for the practicing Gastroenterologist to be thoroughly familiar with this disease. Compared to adenocarcinoma of the rectum and squamous cell cancer of the anal canal, squamous cell carcinoma of the rectum has different epidemiology, etiology, pathogenesis, and prognosis but, most importantly, requires a different therapeutic approach. This review will examine and summarize the available information regarding this disease from the perspective of the practicing gastroenterologist.

Squamous cell carcinoma of the rectum 21 years after radiotherapy for cervical carcinoma

Squamous cell carcinoma (SCC) of the rectum is an extremely rare malignancy, accounting for 0.1-0.2% of rectal malignancies. It is associated with ulcerative colitis, prior radiation, schistosomiasis, ovarian cancer, endometrial cancer, human papilloma virus, colocutaneous fistulas and colonic duplication. Prior reported cases of SCC of the rectum have involved treatment with brachytherapy and external beam radiation. This case is particularly interesting because of the remote exposure of radiation (21 years previously) and the subsequent development of SCC of the rectum. Although extremely rare, SCC of the rectum can occur decades after radiation exposure.

Metachronous squamous-cell carcinoma of the colon and treatment of rectal squamous carcinoma with chemoradiotherapy

Rectal squamous-cell carcinoma is a rare tumour with an incidence of less than 1 per 1000 cases. We report such a case treated with chemoradiotherapy. The patient developed a metastasis in the spleen and a further squamous tumour in the right colon, both of which were successfully resected. No histological evidence of recurrent rectal tumour has been found. Two years following presentation, the patient remains disease-free although symptomatic from a radiotherapy-induced stricture of the rectum.

Chemo-radiotherapy: an alternative to surgery for squamous cell carcinoma of the rectum--report of six patients and literature review

PURPOSE

Since 1943 [1], only 45 patients of squamous cancer of the rectum have been reported in the published reports and the largest series to date consists of 12 patients. Reports suggest that the primary treatment is surgical resection but, in the light of nonsurgical advances in the treatment of anal squamous cell carcinoma (SCC), we present a review of the literature and report six patients treated by chemoradiation therapy (CRT).

METHOD

A literature search was undertaken using the keywords squamous cell, epidermoid, basaloid and cloacagenic and cancer of rectum and colon to provide evidence for this discussion from studies of surgery, radiation therapy and CRT in rectal SCC. A prospective database of the Mount Vernon Cancer Centre, UK was searched from 1995 to 2005 for patients diagnosed with pure SCC of the rectum.

RESULTS

Six patients with histologically confirmed primary SCC of the rectum were treated with primary combination chemo-radiotherapy according to protocols used for SCC of the anal canal over a 15-year period. Surgery was avoided in four, and they remain disease-free on follow-up.

CONCLUSIONS

Primary CRT, as currently utilized in anal cancer, can be extended to primary SCC of the rectum.

Squamous cell carcinoma of the descending colon: report of a case and literature review

It is very rare that squamous cell carcinoma (SCC) arises from colorectal epithelium. An 89-year-old man was treated in 2001 with chief complaints of anorexia, abdominal pain, and low grade fever. The histological diagnosis as SCC was determined by biopsy during a colonoscopy. We diagnosed primary SCC of the colon because except in the colon no malignant lesions were found by systemic CT. Surgical complete resection was performed. However, he died three months after surgical resection because of hepatic metastasis and cachexia. The prognosis of this disease seems to be worse than that of adenocarcinoma.

Colonic squamous cell carcinoma in ulcerative colitis: Report of a case and review of the literature

Squamous cell carcinoma (SCC) is a rare neoplasm in the colorectum. A case of SCC rising from an area of squamous metaplasia in the rectum is presented in a patient with long-standing ulcerative colitis and perianal warts. This is the first report in the literature describing the evolution of squamous metaplasia in the colonic mucosa into invasive carcinoma over time. Related literature on colorectal SCC and squamous metaplasia, and their relationships with inflammatory bowel disease and human papilloma virus, is reviewed.

A population-based study of colorectal cancer histology in the United States, 1998-2001

BACKGROUND

Histology is an important factor in the etiology, treatment, and prognosis of cancer. The purpose of this study was to descriptively characterize colorectal cancer (CRC) histology in the United States population.

METHODS

Data from cancer registries in the National Program of Cancer Registries (NPCR) or Surveillance, Epidemiology and End Results (SEER) program, representing 88% of the U.S. population, were used in the study. The analysis included 522,630 microscopically confirmed CRC cases diagnosed from 1998-2001.

RESULTS

About 96% of CRCs were adenocarcinomas, approximately 2% were other specified carcinomas (including carcinoid tumors), about 0.4% were epidermoid carcinomas, and about 0.08% were sarcomas. The proportion of epidermoid carcinomas, mucin-producing carcinomas, and carcinoid tumors was greater among females. Several histologic patterns with regard to race and ethnicity existed, including a higher percentage of carcinoid tumors among most non-white populations. With respect to age, higher percentages of sarcomas, mucin-producing adenocarcinomas, signet ring cell tumors, and carcinoid tumors were found in individuals under age 40. Overall, adenocarcinomas were more likely to be diagnosed at regional stages with moderate differentiation. Compared with other adenocarcinomas, signet ring cell tumors were more often poorly differentiated and were at distant stage at diagnosis. Carcinoid tumors and sarcomas were mainly poorly differentiated and were at localized stage at diagnosis. Small cell carcinomas were more likely undifferentiated and were at distant stage at diagnosis.

CONCLUSIONS

To date, this is the largest population-based study to analyze CRC histology in the United States. Distinct demographic and clinical patterns associated with different histologies may be helpful for future epidemiologic, laboratory, and clinical studies.

Aggressive treatment of metastatic squamous cell carcinoma of the rectum to the liver: a case report and a brief review of the literature

Background

Rectal squamous cell carcinoma (SCC) is a rare tumor. The incidence of this malignancy has been reported to be 0.25 to 1 per 1000 colorectal carcinomas. From a review of the English literature 55 cases of SCC of the rectum have been published. In this study we report a rectal metastatic SCC to the liver, discussing the efficacy of aggressive adjuvant and neo-adjuvant therapies on survival and prognosis.

Case presentation

A 39-year-old female patient with a pure SCC of the rectum diagnosed endoscopically is presented. The patient underwent initially neoadjuvant chemo-radiotherapy and then abdominoperineal resection with concomitant bilateral oophorectomy and hysterectomy, followed by adjuvant chemo-radiotherapy. Five months after the initial operation liver metastasis was demonstrated and a liver resection was carried out, followed by adjuvant chemotherapy. Eighteen months after the initial operation the patient is alive.

Conclusion

Although prognosis of rectal SCC is worse than that of adenocarcinoma, an aggressive therapeutic approach with surgery as the primary treatment, followed by combined neo- and adjuvant chemo-radiotherapy, may be necessary in order to improve survival and prognosis.

Management of Less Common Tumors of the Colon, Rectum, and Anus

The majority of colorectal and anal malignancies are adenocarcinomas and squamous cell cancers, respectively. Despite the predominance of these neoplasms in these locations, rare histiotypes of the colon, rectum, and anus do occur. These histotypes include but are not limited to lymphoma, melanoma, diffuse cavernous hemangioma, and sarcomas, such as leiomyosarcoma or Kaposi's sarcoma. These tumors often present challenges to clinicians with respect to diagnosis, staging, management, and pathology because of their unfamiliarity. A Medline search using "colon," "rectum,""anus," "lymphoma," "melanoma," "diffuse cavernous hemangioma," "squamous cell carcinoma," "carcinoid," "sarcoma," "leiomyosarcoma," "Kaposi's sarcoma," "Paget's disease," "Bowen's disease," and "basal cell carcinoma" as key words was performed as well as a cross-referencing of the bibliography cited in each work. Rare tumors of the colon, rectum, and anus present diagnostic and management dilemmas for clinicians. Because of their infrequency and poor prognosis, the optimal management of these tumors is controversial. For some histotypes, such as squamous cell carcinoma and carcinoids of the rectum, treatment depends on location and size of the tumor. For uncommon anal lesions, such as Bowen's disease, Paget's disease, and basal cell carcinoma, wide local excision (WLE) with negative margins is the standard of care. For other lesions such as anorectal melanoma or leiomyosarcoma, abdominal perineal resection versus WLE is still being debated. Because the optimal treatment of these tumors is still unclear, we recommend a multidisciplinary approach including a surgeon, primary care physician, medical oncologist, radiation oncologist, and pathologist to offer the patient the best outcome.

Squamous cell carcinoma of the rectum: a case report and review of the literature

Squamous cell carcinoma of the colon and rectum are extremely rare neoplasms. Many questions regarding their histogenesis and biological behaviour remain unanswered. Surgery is the most effective therapy, and adjuvant chemotherapy and radiotherapy should be considered, especially for node-positive patients. We present a patient with squamous cell carcinoma of the middle rectum who underwent abdominoperineal resection and postoperative adjuvant chemotherapy. The pertinent literature is reviewed.

Primary squamous-cell carcinoma of the rectum: report of six cases and review of the literature

PURPOSE

The majority of colorectal carcinomas diagnosed are adenocarcinomas. Squamous-cell carcinoma is a rare pathologic curiosity. Since 1943, only 18 cases have been described in the medical literature. The aim of this study was to report retrospectively six new cases and to review the medical literature.

PATIENTS

Of the 6 cases, 4 were females, and age ranged from 43 to 93 years. Tumors were located 7 to 12 (mean, 8.5) cm from the anal verge. Five patients underwent surgical resection. Intraoperative radiotherapy was performed in one case. One patient was treated only by external beam radiotherapy. In two cases neoadjuvant combination of external beam radiotherapy and chemotherapy and in one case neoadjuvant contact x-ray treatment were performed. This treatment was followed by external beam radiotherapy in two cases and by chemotherapy in two cases, in patients with lymph node involvement.

RESULTS

The clinical tumor response to radiotherapy was almost complete for the patient who did not undergo surgery. One tumor was sterilized by preoperative radiation. Three patients were alive without recurrence at 6 months, 2 years, and 16 years.

CONCLUSION

The etiopathogenicity of squamous-cell carcinoma of the rectum is discussed. The prognosis of these tumors seems to be worse than that for adenocarcinoma because of a delayed diagnosis. Surgical resection seems to be the most important treatment. Chemotherapy and especially radiotherapy may have some indications.

Squamous cell carcinoma of the colon with an elevated serum squamous cell carcinoma antigen responding to combination chemotherapy

Primary squamous cell colorectal carcinomas are uncommon, and their characteristics are not well known. They seem to occur most commonly in the fifth decade of life with a slight predominance for men. The most commonly reported anatomic locations are the rectum and the proximal colon. Clinical features and common diagnostic methods do not easily differentiate squamous cell colorectal carcinomas from adenocarcinomas. Because of their extremely rare occurrence, it is difficult to study their natural course, clinical behavior, and response to therapy. This report presents the case of a pure squamous cell colorectal cancer and provides a brief review of the literature, which includes 60 previously published cases. The case of a patient with T3N2M0 primary squamous cell carcinoma of the rectosigmoid colon, which was initially treated with abdominoperineal resection followed by adjuvant chemotherapy and radiation, is presented. During the follow-up, an elevated squamous cell carcinoma antigen (SCC Ag) level led to restaging computed tomography scans, which confirmed recurrent metastatic disease in the liver. Response to chemotherapy with a decrease in tumor size correlated with a decrease in the serum SCC Ag level. Although SCC Ag has been used as a tumor marker for squamous cell cancers of the lung, head and neck, uterine cervix, and esophagus, this is the first reported case of a squamous cell colon carcinoma presenting with an elevated SCC Ag at the time of recurrence. In addition, this patient showed an objective partial response to combination chemotherapy, with a decrease in the serum level of this tumor marker.

Adenosquamous and squamous carcinoma of the colon and upper rectum: a clinical and histopathologic study

PURPOSE

Squamous and adenosquamous carcinoma of the colon and proximal rectum are rare neoplasms in which the clinicopathologic behavior and the most appropriate management are unknown. The purpose of this study was to review the histology and clinical course of the largest series of cases ever reported from a single center on this rare condition.

METHOD

The Mayo Clinic tissue registry was searched for all primary cases of squamous and adenosquamous carcinoma of the colon or rectum proximal to 8 cm from the dentate and presenting before December 31, 1992. Of the 52 identified cases there was adequate histologic material for review in 44 cases. These cases were divided into pure squamous-cell carcinoma (n = 11), mixed adenosquamous carcinoma (n = 31), and adenocarcinoma with benign-appearing squamous metaplasia (adenoacanthoma; n = 2). Squamous-cell carcinomas were examined for evidence of human papilloma virus by in situ hybridization. A retrospective review of medical records was undertaken in all 52 cases with respect to predisposing factors, clinicopathologic behavior, prognostic features, and treatment with adjuvant therapy.

RESULTS

The charts of 52 patients (20 females), with a mean age of 58.6 (range, 19-90) years, were reviewed. Right-sided lesions were the most common (43 percent). Metastatic disease was evident at presentation in 49 percent of patients, the most common sites in order being liver, peritoneal, and lung. The five-year overall survival rate was 34 percent, Stage I to III disease had a 65 percent five-year survival rate, and Stage IV mean survival time was 8.5 months. For node-positive and node-negative disease, 23 and 85 percent, respectively, survived five years. There was no evidence of human papilloma virus in the six squamous-cell carcinomas examined.

CONCLUSION

Squamous and adenosquamous carcinomas of the colon and rectum are rare neoplasms. Although a poor prognosis can be expected for node-positive disease, patients with negative nodes do generally the same as patients with adenocarcinoma histology. Based on advances made with multimodality therapy of squamous-cell cancer of the anus and adenocarcinoma of the rectum, further studies should define the role of postoperative therapies for these lesions.