Pratap Singh Adarsh, Kumar Amit, Dhar Anita, Agarwal Shipra, Bhimaniya Sudhir
Department of Surgery, AIIMS, New Delhi, India.
Department of Pathology, AIIMS, New Delhi, India.
J Med Case Rep. 2018 Oct 11;12(1):304. doi: 10.1186/s13256-018-1831-8.
Colorectal carcinoma in the pediatric age group is rare and tends to be very aggressive and present late, due to which it has a very poor prognosis. It may present with distant metastasis; however, metastasis to the testes is very rare and signifies an advanced stage of the disease. Surgery is the only effective modality to cure patients with localized colorectal carcinomas. However, statistics show a higher incidence of unresectable disease and a higher metastasis rate in childhood colorectal carcinomas. We present a case of advanced colorectal carcinoma with testicular metastasis in an adolescent.
A 15-year-old Indian Hindu boy presented to surgical emergency with signs and symptoms of intestinal obstruction. He also had a history of passing blood and mucus per rectum. On examination he had abdominal distension. On digital rectal examination, a circumferential proliferative growth was felt 1 cm above the anal verge. On scrotal examination, a small nodule was felt in his right testis. In view of intestinal obstruction, he was taken into our emergency operation theater and a diverting loop sigmoid colostomy was performed to relieve the obstruction. A punch biopsy from anorectal growth was taken which suggested signet ring cell adenocarcinoma. Contrast-enhanced computed tomography of his chest, abdomen, and pelvis showed advanced colorectal carcinoma with distant metastasis. Ultrasonography of his testes showed a hypoechoic nodule in the right testis from which a needle aspiration biopsy was done which revealed metastatic adenocarcinoma.
Childhood colorectal carcinomas have a very poor prognosis due to their aggressive nature and late presentation. In spite of all the advances in diagnosis and treatments, the overall long-term survival is still dismal in these patients. Due to the rarity of this disease, screening is not recommended for individuals under the age of 50. Thus, to improve outcome, early diagnosis and treatment is paramount. For that to happen, awareness needs to be created regarding pediatric colorectal carcinoma and its signs and symptoms.
小儿年龄段的结直肠癌较为罕见，往往侵袭性很强且就诊时已属晚期，因此预后很差。它可能会出现远处转移；然而，转移至睾丸极为罕见，意味着疾病已处于晚期。手术是治愈局限性结直肠癌患者的唯一有效方式。然而，统计数据显示儿童结直肠癌中不可切除疾病的发生率较高且转移率也较高。我们报告一例青少年晚期结直肠癌伴睾丸转移的病例。
一名15岁的印度印度教男孩因肠梗阻的症状和体征就诊于外科急诊。他还有直肠便血和黏液便的病史。检查时发现他有腹胀。直肠指检时，在肛门边缘上方1厘米处摸到一个环形增生性肿物。阴囊检查时，在其右侧睾丸摸到一个小结节。鉴于肠梗阻，他被送入我们的急诊手术室，进行了转流性乙状结肠造口术以缓解梗阻。对肛管直肠肿物进行了穿刺活检，提示印戒细胞腺癌。胸部、腹部和盆腔的增强计算机断层扫描显示晚期结直肠癌伴远处转移。睾丸超声检查显示右侧睾丸有一个低回声结节，对其进行了针吸活检，结果显示为转移性腺癌。
儿童结直肠癌因其侵袭性和就诊晚而预后很差。尽管在诊断和治疗方面取得了所有进展，但这些患者的总体长期生存率仍然很低。由于这种疾病罕见，不建议对50岁以下的个体进行筛查。因此，为改善预后，早期诊断和治疗至关重要。要实现这一点，需要提高对小儿结直肠癌及其症状体征的认识。
