Multiple polypoid colonic metastases from rectal adenocarcinoma with signet ring cells features: a case report
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CASE REPORT
Multiple polypoid colonic metastases from rectal adenocarcinoma with signet ring cells features: a case report Yunlong Wu1†, Jiaolin Zhou1†, Tongtong Liu2, Lai Xu1 and Yi Xiao1*
Abstract Background: Multiple polypoid colonic metastases are very rare which mainly originated from gastric carcinoma or melanoma. For rectal cancers, liver, lung and peritoneum are the most common metastatic sites. Here we present an unusual case with rectal adenocarcinoma and metachronous multiple colonic polypoid metastases. Case presentation: A 53-year-old man who underwent radical resection for rectal cancer 2 years ago was admitted to our department for an elevation of CEA level of 18.4 ng/ml. Colonoscopy revealed ten ivory rubbery colonic polypoid lesions (about 5 mm in diameters) in the large bowel which were confirmed as signet ring cell carcinomas (SRCC) by biopsy, but full-body contrast enhanced CT and PET-CT showed no other suspicious lesion. Seven weeks later, a laparoscopic total colectomy was performed and more than 50 polypoid lesions were observed throughout the mucosal surface of the large intestine which were confirmed as metastatic SRCC by postoperative pathological examination. All the 34 paracolic lymph nodes retrieved were involved. After 4 months, diffuse abdominopelvic and multiple bone metastases were identified by CT and the patient died of the disease 1 month later. Conclusion: Here we present an unusual case of multiple colonic polypoid metastases of rectal adenocarcinoma. For SRCC that is prone to have disseminated micrometastases, colonic ‘polyps’ may be the early noticeable sign of undetectable and extensive tumor spread. Instead of surgical resection of ‘the confined disease in colon’, systemic treatment maybe a more appropriate choice. Keywords: Rectal cancer, Signet ring cell carcinoma, Metastasis, Endoscopy, Imaging studies Background Multiple polypoid colonic metastases from other distant gastrointestinal carcinomas are extremely rare, only a few cases have been reported in the literatures [1–7]. Among these cases, colonic metastases were mainly originated from gastric carcinoma or melanoma, with signet ring cell features being the most common histological type. *Correspondence: [email protected] † Yunlong Wu and Jiaolin Zhou have contributed equally to this work 1 Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, China Full list of author information is available at the end of the article
Signet ring cell carcinoma (SRCC) is a rare subtype of colorectal cancer, accounting for about 1% of all rectal cancers [8, 9]. Patients with SRCCs often present with distinct clinical features and poor prognosis [10, 11]. The most common sites of metastases from rectal cancer are the liver, lung, and peritoneum. Here, we report an unusual rectal cancer case with metachronous multiple colonic polypoid metastases.
Case presentation A 53-year-old m
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