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Synchronous Adenocarcinoma of the Colon and Rectal Carcinoid

View Article: PubMed Central - PubMed

ABSTRACT

Primary colonic adenocarcinoma and synchronous rectal carcinoids are rare tumors. Whenever a synchronous tumor with a nonmetastatic carcinoid component is encountered, its prognosis is determined by the associate malignancy. The discovery of an asymptomatic gastrointestinal carcinoid during the operative treatment of another malignancy will usually only require resection without additional treatment and will have little effect on the prognosis of the individual. This article reports a synchronous rectal carcinoid in a patient with hepatic flexure adenocarcinoma. We present a case of a 46-year-old Hispanic woman with a history of hypothyroidism, uterine fibroids and hypercholesterolemia presenting with a 2-week history of intermittent abdominal pain, mainly in the right upper quadrant. She had no family history of cancers. Physical examination was significant for pallor. Laboratory findings showed microcytic anemia with a hemoglobin of 6.6 g/dl. CT abdomen showed circumferential wall thickening in the ascending colon near the hepatic flexure and pulmonary nodules. Colonoscopy showed hepatic flexure mass and rectal nodule which were biopsied. Pathology showed a moderately differentiated invasive adenocarcinoma of the colon (hepatic flexure mass) and a low-grade neuroendocrine neoplasm (carcinoid of rectum). The patient underwent laparoscopic right hemicolectomy and chemotherapy. In patients diagnosed with adenocarcinoma of the colon and rectum, carcinoids could be missed due to their submucosal location, multicentricity and indolent growth pattern. Studies suggest a closer surveillance of the GI tract for noncarcinoid synchronous malignancy when a carcinoid tumor is detected and vice versa.

No MeSH data available.


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a Rectal biopsy with neuroendocrine tumor (carcinoid). Tumor cells are arranged in groups and form acini in the submucosa. HE. Low power, ×100. b Rectal biopsy with neuroendocrine tumor (carcinoid) cells strongly immunoreactive to chromogranin A. Immunohistochemical stain. ×400.
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Figure 3: a Rectal biopsy with neuroendocrine tumor (carcinoid). Tumor cells are arranged in groups and form acini in the submucosa. HE. Low power, ×100. b Rectal biopsy with neuroendocrine tumor (carcinoid) cells strongly immunoreactive to chromogranin A. Immunohistochemical stain. ×400.

Mentions: A 46-year-old Hispanic woman with a medical history of hypothyroidism, uterine fibroids and hypercholesterolemia came to the emergency room (ER) with a 2-week history of intermittent pain in the right upper quadrant of the abdomen. She described the pain as colicky, nonradiating with no aggravating or relieving factors. She also reported two episodes of loose stools 2 days prior to the ER visit. She did not report any nausea, vomiting, hematemesis, melena, hematochezia or constipation. She also denied any change in appetite or weight. She did not undergo any abdominal surgeries in the past. There was no history of any gastrointestinal malignancies in the family. She denied using tobacco, alcohol or recreational drugs. On initial evaluation, she was noted to have pallor. Her gastrointestinal examination did not reveal any abdominal distension, palpable masses or free fluid. Laboratory evaluation revealed microcytic anemia with a hemoglobin of 6.6 g/dl. Her liver function tests and chemistry panel were within normal limits. A computed tomogram (CT) of the abdomen was done which showed a 7.5-cm-long segment of circumferential wall thickening in the ascending colon extending up to the hepatic flexure area. Flexible colonoscopy was performed under monitored anesthesia care for further evaluation that showed a hepatic flexure mass extending to the ascending colon and a rectal nodule (fig 1a, b). Pathological findings of the mass revealed moderately differentiated invasive adenocarcinoma (fig 2) for which the patient underwent laparoscopic right hemicolectomy. The rectal nodule on microscopic assessment showed a low-grade neuroendocrine neoplasm suggestive of carcinoid tumor (fig 3a, b). Of the 17 lymph nodes resected during laparotomy, one was positive for metastasis, but there was vascular invasion of the tumor. The CT scan done for staging showed pulmonary nodules concerning for metastasis. The patient was started on chemotherapy with folinic acid, fluorouracil, oxiplatin (FOLFOX) and bevacizumab for management of stage IV colon cancer.


Synchronous Adenocarcinoma of the Colon and Rectal Carcinoid
a Rectal biopsy with neuroendocrine tumor (carcinoid). Tumor cells are arranged in groups and form acini in the submucosa. HE. Low power, ×100. b Rectal biopsy with neuroendocrine tumor (carcinoid) cells strongly immunoreactive to chromogranin A. Immunohistochemical stain. ×400.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121549&req=5

Figure 3: a Rectal biopsy with neuroendocrine tumor (carcinoid). Tumor cells are arranged in groups and form acini in the submucosa. HE. Low power, ×100. b Rectal biopsy with neuroendocrine tumor (carcinoid) cells strongly immunoreactive to chromogranin A. Immunohistochemical stain. ×400.
Mentions: A 46-year-old Hispanic woman with a medical history of hypothyroidism, uterine fibroids and hypercholesterolemia came to the emergency room (ER) with a 2-week history of intermittent pain in the right upper quadrant of the abdomen. She described the pain as colicky, nonradiating with no aggravating or relieving factors. She also reported two episodes of loose stools 2 days prior to the ER visit. She did not report any nausea, vomiting, hematemesis, melena, hematochezia or constipation. She also denied any change in appetite or weight. She did not undergo any abdominal surgeries in the past. There was no history of any gastrointestinal malignancies in the family. She denied using tobacco, alcohol or recreational drugs. On initial evaluation, she was noted to have pallor. Her gastrointestinal examination did not reveal any abdominal distension, palpable masses or free fluid. Laboratory evaluation revealed microcytic anemia with a hemoglobin of 6.6 g/dl. Her liver function tests and chemistry panel were within normal limits. A computed tomogram (CT) of the abdomen was done which showed a 7.5-cm-long segment of circumferential wall thickening in the ascending colon extending up to the hepatic flexure area. Flexible colonoscopy was performed under monitored anesthesia care for further evaluation that showed a hepatic flexure mass extending to the ascending colon and a rectal nodule (fig 1a, b). Pathological findings of the mass revealed moderately differentiated invasive adenocarcinoma (fig 2) for which the patient underwent laparoscopic right hemicolectomy. The rectal nodule on microscopic assessment showed a low-grade neuroendocrine neoplasm suggestive of carcinoid tumor (fig 3a, b). Of the 17 lymph nodes resected during laparotomy, one was positive for metastasis, but there was vascular invasion of the tumor. The CT scan done for staging showed pulmonary nodules concerning for metastasis. The patient was started on chemotherapy with folinic acid, fluorouracil, oxiplatin (FOLFOX) and bevacizumab for management of stage IV colon cancer.

View Article: PubMed Central - PubMed

ABSTRACT

Primary colonic adenocarcinoma and synchronous rectal carcinoids are rare tumors. Whenever a synchronous tumor with a nonmetastatic carcinoid component is encountered, its prognosis is determined by the associate malignancy. The discovery of an asymptomatic gastrointestinal carcinoid during the operative treatment of another malignancy will usually only require resection without additional treatment and will have little effect on the prognosis of the individual. This article reports a synchronous rectal carcinoid in a patient with hepatic flexure adenocarcinoma. We present a case of a 46-year-old Hispanic woman with a history of hypothyroidism, uterine fibroids and hypercholesterolemia presenting with a 2-week history of intermittent abdominal pain, mainly in the right upper quadrant. She had no family history of cancers. Physical examination was significant for pallor. Laboratory findings showed microcytic anemia with a hemoglobin of 6.6 g/dl. CT abdomen showed circumferential wall thickening in the ascending colon near the hepatic flexure and pulmonary nodules. Colonoscopy showed hepatic flexure mass and rectal nodule which were biopsied. Pathology showed a moderately differentiated invasive adenocarcinoma of the colon (hepatic flexure mass) and a low-grade neuroendocrine neoplasm (carcinoid of rectum). The patient underwent laparoscopic right hemicolectomy and chemotherapy. In patients diagnosed with adenocarcinoma of the colon and rectum, carcinoids could be missed due to their submucosal location, multicentricity and indolent growth pattern. Studies suggest a closer surveillance of the GI tract for noncarcinoid synchronous malignancy when a carcinoid tumor is detected and vice versa.

No MeSH data available.


Related in: MedlinePlus