Salimiaghdam Nasim, Mustafa Ahmed, Pokuaa Irene O, Hamidi Afshin, Chen Emily
Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA.
Internal Medicine, Capital Health Regional Medical Center, Trenton, USA.
Cureus. 2025 Jun 24;17(6):e86669. doi: 10.7759/cureus.86669. eCollection 2025 Jun.
Carcinoma of the ascending colon, especially the medullary type, is a rare and poorly differentiated form of colorectal cancer. This case report details a case of a 75-year-old woman with a background of cardiovascular issues, hypertension, and dementia who presented with complete large bowel obstruction and was found to have poorly differentiated carcinoma of the ascending colon with medullary features. The surgical approach involved an exploratory laparotomy followed by a right hemicolectomy. The pathological analysis confirmed a pT3N0M0, G3 stage II tumor, characterized by a loss of MLH1 and PMS2 protein expression, indicating microsatellite instability (MSI-H). Since there was no nodal involvement, adjuvant chemotherapy wasn't deemed necessary. The patient was encouraged to keep up with regular follow-ups, which would include monitoring carcinoembryonic antigen (CEA) levels, a complete metabolic panel (CMP), a complete blood count (CBC), and CT imaging every six months and annually. Although CEA is the most established tumor marker in colorectal cancer, it is still part of the follow-up plan, owing to its lack of sensitivity in the medullary subtype. In addition to this, the recommendation was for a surveillance colonoscopy every three years. This report sheds light on the case's pathological, clinical, and follow-up elements, emphasizing the need for personalized patient management.
升结肠癌，尤其是髓样型，是一种罕见且分化程度低的结直肠癌形式。本病例报告详细介绍了一名75岁女性患者，她有心血管问题、高血压和痴呆病史，因完全性大肠梗阻就诊，被发现患有具有髓样特征的低分化升结肠癌。手术方法包括剖腹探查术，随后进行右半结肠切除术。病理分析证实为pT3N0M0，G3 II期肿瘤，其特征是MLH1和PMS2蛋白表达缺失，表明微卫星不稳定（MSI-H）。由于没有淋巴结受累，不认为需要辅助化疗。鼓励患者定期随访，包括每六个月和每年监测癌胚抗原（CEA）水平、全套代谢检查（CMP）、全血细胞计数（CBC）和CT成像。尽管CEA是结直肠癌中最常用的肿瘤标志物，但由于其在髓样亚型中缺乏敏感性，它仍是随访计划的一部分。除此之外，建议每三年进行一次监测性结肠镜检查。本报告阐明了该病例的病理、临床和随访情况，强调了个性化患者管理的必要性。
