Colorectal Surgery Unit, Hamad Medical Corporation, Doha, Qatar.
Laboratory and Pathology Department, Hamad Medical Corporation, Doha, Qatar.
J Med Case Rep. 2023 Oct 18;17(1):434. doi: 10.1186/s13256-023-04160-0.
Medullary carcinoma of the colon is a rare subtype of colorectal cancer that has a unique, and sometimes varied, clinical and histologic profile. It usually presents in adult patients older than 50 years. Here, we report a unique case of young male patient who initially presented with abdominal pain followed by a large bowel obstruction.
A 40-year-old SriLankan male presented with right-sided abdominal pain and on examination, there was a palpable right iliac fossa mass. Colonoscopy and a computed tomography scan revealed cecal mass. Later, while waiting for elective resection, the patient developed symptoms and signs of a large bowel obstruction. He underwent a laparoscopic right hemicolectomy with an uneventful postoperative course. The histopathologic evaluation of the resected specimens showed invasive carcinoma with syncytial growth pattern, foci of lymphoid host response, and dirty necrosis, in keeping with a medullary carcinoma pT4a pN2b. Unlike most reported medullary carcinoma cases, this patient was young and caudal-related homeobox transcription factor 2 positive.
We have reported another case of medullary carcinoma of the colon in a young patient with unique histologic characteristics. Reporting such cases helps in refine understanding of the histologic and genetic, as well as clinical, phenotypes of medullary carcinoma of the colon.
结直肠髓样癌是一种罕见的结直肠癌亚型，具有独特的、有时多样的临床和组织学特征。它通常发生在 50 岁以上的成年患者中。在这里，我们报告了一个年轻男性患者的独特病例，他最初表现为腹痛，随后出现大肠梗阻。
一名 40 岁的斯里兰卡男性出现右侧腹痛，体格检查可触及右髂窝肿块。结肠镜检查和计算机断层扫描显示盲肠肿块。后来，在等待择期切除时，患者出现了大肠梗阻的症状和体征。他接受了腹腔镜右半结肠切除术，术后无并发症。切除标本的组织病理学评估显示浸润性癌伴合胞体生长模式、淋巴样宿主反应灶和污秽性坏死，符合髓样癌 pT4a pN2b。与大多数报道的髓样癌病例不同，该患者年轻且尾侧同源盒转录因子 2 阳性。
我们报告了另一个年轻患者的结直肠髓样癌病例，具有独特的组织学特征。报告这些病例有助于细化对结直肠髓样癌的组织学、遗传学以及临床表型的理解。
