Immature enteric ganglion cells were observed in a 13-year-old colon signet ring cell carcinoma patient: A case report and literature review

Signet-ring colorectal carcinoma

Introduction. Colorectal cancer is the third most common cancer worldwide. Signet-ring carcinoma is an extremely rare subtype of colorectal cancer, with frequency ranges 0.3?4.6%. The diagnosis of this type of cancer is based on pathohistological analysis. Case outline. A 58-year-old patient was admitted due to abdominal pain and abdominal swelling. The physical findings indicated abdomen above the level of the chest, soft, painfully sensitive in the left hemiabdomen, with positive clinical signs of ascites. Laboratory analyzes indicated positive inflammatory syndrome, elevation of D-dimer and CA-19-9. Ascites analysis showed the presence of malignant cells. Computed tomography revealed hepatomegaly, liver steatosis, as well as multiple secondary deposits in the liver, ascites, and peritoneal implants. Colonoscopy showed ulceration of the right colon, which was covered with fibrin. The pathohistological findings indicated poorly differentiated, invasive adenocarcinoma of the signet ring carcinoma type. The patient was treated with analgesics, diuretics, proton pump inhibitors, beta 2 blockers, angiotensin-converting enzyme inhibitors, low-molecular-weight heparin, antibiotics, and supportive therapy. The patient was discharged after 10 days of hospitalization. He was presented to the multidisciplinary team, which decided on further symptomatic therapy. Conclusion. Signet-ring colon cancer is a rare, aggressive tumor with a poor prognosis. Although it is most often localized in the stomach, it is necessary to think about the colorectal localization of this tumor in the differential diagnosis of patients with colonic complaints, especially if they have ?alarm symptoms? and if they are younger.

A rare cause of intestinal obstruction in children: signet-ring cell adenocarcinoma of the colon

BACKGROUND

Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes.

METHODS

We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma.

RESULTS

Six patients, three boys and three girls, with a mean age of 14.83 (range, 13-17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then.

CONCLUSION

Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.

Primary signet ring cell carcinoma with tubular adenoma of the rectum: A case report and a review of the literature

RATIONALE

Among the various forms of colorectal carcinomas, primary signet ring cell carcinoma (SRCC) of rectum is infrequent. Primary SRCC with adenoma is even rarer. Due to its low morbidity and lack of obvious manifestations at early stages, it is difficult to make an early diagnosis and perform surgical intervention in time. Herein, we reported a case of primary SRCC with tubular adenoma of rectum and also performed a review of the literature of such cases, in hopes of expanding the general understanding regarding such cases.

PATIENT CONCERNS

A 61-year-old male patient presented with rectal bleeding for 1 week.

DIAGNOSES

A neoplasm could be palpated through a rectal examination, with a size of 4.0 cm by 3.0 cm, at a distance of 5 cm from the anal edge. Magnetic resonance imaging examination and colonoscopies were performed to confirm the finding, and 4 tissue specimens were obtained for histopathologic biopsy. The result of biopsy was high-grade intraepithelial neoplasia with an adenoma component.

INTERVENTIONS

Surgical resection was performed, and histopathologic and immunohistochemical staining examination of the resection confirmed the diagnosis of SRCC with tubular adenoma.

OUTCOMES

The patient was discharged from hospital 12 days postsurgery, without any complications. Further chemotherapy and supportive treatments were suggested to him and will be followed at a local hospital.

LESSONS

Primary rectal SRCC has a rather low morbidity. Furthermore, a rectal SRCC with adenoma which was presenting in this case is even more rare. Besides lack of clinical characters, delay of diagnosis and treatment frequently occur. So far, a surgical procedure has still been one of the most effective treatments. Considering of metastasis and the poor prognosis, early diagnosis, in-time radical resection, and a comprehensive followed treatment are recommended for a higher 5-year overall survival.

Does radiotherapy prior to surgery improve long term prognosis in pediatric colorectal cancer in lower- and upper-middle income countries with limited resources? Our experience and literature review

Colorectal carcinoma in children and adolescents is extremely rare, with an annual incidence <0.3 cases per million, most frequently reported in the second decade of life. It accounts for severe morbidity and poor prognosis owing to the low index of suspicion, delayed diagnosis, advanced stage at presentation and the aggressive tumor nature. Patients present with abdominal pain, vomiting, constipation, abdominal distension, rectal tenesmus, iron-deficiency anemia, change in bowel habit and weight loss. Rectal bleeding is an uncommon presentation in children. Bowel obstruction presents frequently in children compared to adults. In 90% of pediatric cases, colorectal carcinoma occurs sporadically. In 10%, predisposing conditions and syndromes are identified. We present a case study of a 12-year-old female with advanced colorectal cancer without a predisposing disease or syndrome, who received radio-chemotherapy ten weeks prior to radical abdominopelvic surgery, followed by radio-chemotherapy postoperatively, with a positive outcome.