A Rare Presentation of Carcinoma Post Cricoid with Unusual Synchronous Primary Malignancy in the Sigmoid Colon
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CASE REPORT
A Rare Presentation of Carcinoma Post Cricoid with Unusual Synchronous Primary Malignancy in the Sigmoid Colon Zeeba Usofi 1 & T. Subramanyeshwar Rao 1 & Chandrasekhar S. Rao 2 & Sujit Patnaik 1 & Daphne Fonseca 3 Received: 29 April 2020 / Accepted: 20 August 2020 # Indian Association of Surgical Oncology 2020
Introduction A synchronous malignancy is the one that is diagnosed simultaneously or within 6 months of the index tumor, while a metachronous SPM is diagnosed greater than 6 months after the index tumor. Patients with head and neck squamous cell carcinoma (HNSCC) are at increased risk for the development of a second primary malignancy (SPM), within the upper aerodigestive tract [1]. This is based on the concept of field cancerization. The concept, introduced by Slaughter et al. [2], who discovered that in oral cancers, establishes that the epithelium beyond the boundaries of the tumor possessed histologic changes. But the cancer which develops in the background of field cancerization is of the same histology. For example, in case of oral cancer, the histology is squamous cell carcinoma. However, a synchronous malignancy with a different histology is rare and is unreported. We hereby report an incidentally detected synchronous adenocarcinoma in the sigmoid colon alongside squamous cell carcinoma in the post cricoid region in a 51-year-old lady.
Case Presentation A 51-year-old lady presented with dysphagia for 1 month with dysphagia for solids progressing to liquids. She had no other * Zeeba Usofi [email protected] 1
Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Banjara Hills, Road no 10, Hyderabad, Telangana 500034, India
2
Department of Head and Neck Oncology, Basavatarakam Indo American Cancer Hospital, Hyderabad, Telangana, India
3
Department of Pathology, Basavatarakam Indo American Cancer Hospital, Hyderabad, Telangana, India
symptoms pertaining to the gastrointestinal tract. Clinically, the post cricoid lesion did not show any signs of locally advanced nature, and there was no other finding on abdominal examination. Upper g astrointestinal endoscopy revealed an ulceroproliferative growth in the post cricoid region extending to cervical esophagus with the scope not negotiable beyond the growth. The biopsy taken revealed a well-differentiated squamous cell carcinoma. A whole body PET CT scan was done to assess the stage of the primary and to rule out distant metastasis. The scan revealed a FDG avid lesion with circumferential soft tissue thickening in post cricoid region extending to the cervical esophagus with SUVmax of 18.0, preserved fat planes with prevertebral fascia, and no significant cervical lymphadenopathy. To our surprise, the scan also revealed an intensely avid FDG lesion with subtle wall thickening involving the sigmoid colon with SUVmax of 10.0 (Fig. 1). This was and unexpected finding. Subsequently colonoscopy revealed a rectosigmoid growth, and the biopsy was suggestive of a well to moderately differentiated ad
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