Elmore Leslie R, Drymon Alexandra, Toca Angel, Gritsiuta Andrei I, Gilleland William
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
AME Case Rep. 2024 Sep 13;8:109. doi: 10.21037/acr-24-87. eCollection 2024.
Collision tumors of the gastrointestinal (GI) tract are thought to be uncommon, with those of the colon being rare with very few cases reported in current literature. There are three proposed theories regarding the etiology of collision tumors currently, including the "double primaries", the "biclonal malignant transformation", and the "tumor-to-tumor carcinogenesis" theories. Prognosis of collision tumors remains unclear. To our knowledge, this is the fifth case of a collision carcinoma involving the cecum and ileocecal valve and the first report of a collision carcinoma including both mucinous adenocarcinoma and neuroendocrine tumor of the cecum and the ileocecal valve. The aim of this paper is to explore the history of collision tumors and associated nomenclature, defined diagnostic criteria, and proposed theories for etiology in addition to patient presentation, approach to diagnosis, treatment options, and prognosis.
We present the case of an 83-year-old female who presented to the emergency room with a 4-month history of cramping abdominal pain associated with nausea, emesis, and decreased appetite with associated weight loss. Diagnostic imaging demonstrated a bowel obstruction secondary to a mass in the cecum and she underwent an exploratory laparotomy with right hemicolectomy. She was found to have a collision carcinoma of the cecum and ileocecal valve containing both mucinous adenocarcinoma and neuroendocrine tumor. Diagnosis was confirmed post-operatively with pathologic examination and immunohistochemical testing.
Diagnosing collision tumors upon patient presentation is exceedingly difficult as the symptoms are often identical to other neoplasms of the GI tract and vary based on location of the tumor. It is thought that the true prevalence of collision tumors is underestimated due to history of changing nomenclature, unclear diagnostic criteria, unreported cases, and unrecognized cases. Furthermore, new advances in immunohistochemical evaluation have allowed for better characterization of these neoplasms. With clarification regarding nomenclature, diagnostic criteria and expanding awareness, it is our hope that this leads to an increase in reported cases, allowing for an expanded discussion and resulting growth of literature and further studies. Further knowledge regarding the pathogenesis, treatment, and prognosis is needed.
胃肠道碰撞瘤被认为不常见，其中结肠碰撞瘤罕见，当前文献报道的病例极少。目前关于碰撞瘤的病因有三种假说，包括“双原发”、“双克隆恶性转化”和“肿瘤至肿瘤致癌”假说。碰撞瘤的预后仍不明确。据我们所知，这是第五例累及盲肠和回盲瓣的碰撞癌病例，也是首例同时包含盲肠和回盲瓣黏液腺癌及神经内分泌肿瘤的碰撞癌报道。本文旨在探讨碰撞瘤的历史及相关命名、明确的诊断标准、病因假说，此外还包括患者表现、诊断方法、治疗选择及预后。
我们报告一例83岁女性患者，因4个月的腹部绞痛病史就诊于急诊室，伴有恶心、呕吐、食欲减退及体重减轻。诊断性影像学检查显示盲肠肿物导致肠梗阻，患者接受了剖腹探查及右半结肠切除术。术中发现患者患有盲肠和回盲瓣碰撞癌，包含黏液腺癌和神经内分泌肿瘤。术后经病理检查及免疫组化检测确诊。
在患者就诊时诊断碰撞瘤极其困难，因为其症状通常与其他胃肠道肿瘤相同，且因肿瘤位置而异。由于命名变化、诊断标准不明确、病例未报告及未被识别等原因，碰撞瘤的真实患病率可能被低估。此外，免疫组化评估的新进展有助于更好地对这些肿瘤进行特征描述。随着命名、诊断标准的明确及认识的提高，我们希望这能增加报告病例数，从而展开更广泛的讨论，促进文献增长及进一步研究。还需要进一步了解其发病机制、治疗及预后。
