Dataset Information

Collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma: A case report.

ABSTRACT:

Introduction and importance

Neuroendocrine carcinoma of the colon and rectum account for less than 1% of all colorectal malignancies. Here we report a case of a collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma.

Case presentation

A 46-year-old asymptomatic female with severe anemia was referred by her primary care physician for admission. Initial imaging showed several innumerable heterogenous hypodense lesions within the liver. Following a colonoscopy and the excision of a rectal mass, the histopathology report revealed a Collision tumor.

Clinical discussion

There are no specific clinical features or imaging findings. The diagnosis is made post operatively dependent on histopathology.

Conclusion

It is essential to report these cases to advance a further understanding of the behaviour of these tumors, in addition to develop evidence-based guidelines and treatment strategies.

SUBMITTER: Nannar J

PROVIDER: S-EPMC9110971 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma: A case report.

Nannar Jaspreet J Anciro Alyssa A Nanda Atul K AK

Annals of medicine and surgery (2012) 20220510

<h4>Introduction and importance</h4>Neuroendocrine carcinoma of the colon and rectum account for less than 1% of all colorectal malignancies. Here we report a case of a collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma.<h4>Case presentation</h4>A 46-year-old asymptomatic female with severe anemia was referred by her primary care physician for admission. Initial imaging showed several innumerable heterogenous hypodense lesions within the liver. Following a ...[more]

PMID: 35592827

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Project description:BackgroundCollision 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.Case descriptionWe 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.ConclusionsDiagnosing 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.

Project description:BackgroundCollision tumors are rare cases with two different tumor entities growing synchronously. While adenocarcinoma of the pancreas is the most common pancreatic tumor with an incidence of 10 per 100.000, retroperitoneal liposarcoma remains very rare. This is the first report of a collision tumor between these two tumor entities.Case presentationDemographic details: The tumor was diagnosed in a 64 male Caucasian patient. Besides atrial fibrillation, arterial hypertension and a hypothyroidism there is no relevant medical history especially no history of cancer. Clinical details: During a routine check-up an unclassified tumor of the pancreatic tail was diagnosed. The lab showed no pathologies. Tumor markers were negative for carbohydrate antigen 19-9 and 72-4 (CA 19-9, CA 72-4) and carcinoembryonic antigen (CEA). Alpha-fetoprotein (AFP) and neuron specific enolase (NSE) were both elevated (AFP 97kU/l, (< 5,8kU/l) and NSE 30,0 μg/l (16,4 μg/l)). A computed tomography-guided core needle biopsy was performed which revealed a low-grade liposarcoma (G1). A CT scan showed no metastases. A surgical resection was recommended by the interdisciplinary tumor board.InterventionsA systematic left sided retroperitoneal compartment resection including en-bloc-left sided pancreatectomy, splenectomy, nephrectomy, hemicolectomy, adrenalectomy, partial gastrectomy and partial resection of the diaphragm was performed. Pathology revealed a collision tumor consisting of pancreatic adenocarcinoma that was classified pT3, pN2 (11/33 ece+) L1 V0 Pn0, R0; G2 [UICC Stage III] and a liposarcoma pT2, pN0 (0/33) L0 V0 Pn0, G1 [UICC Stage Ib]. The postoperative tumor board recommended an adjuvant chemotherapy with gemcitabine and capecitabine for the locally advanced pancreatic adenocarcinoma.OutcomeAt the latest follow-up (1 year after surgery) the patient was in good clinical condition and without evidence of tumor recurrence.ConclusionCollision tumors are rare and difficult to diagnose. This is the first description of a collision tumor composed of pancreatic adenocarcinoma and retroperitoneal liposarcoma. The reported case demonstrates that inconsistent diagnostic results (e.g. imaging and pathology) should raise suspicion concerning the diagnosis. Awareness of these rare cases might protect us from underdiagnosing patients and therefore leading to better patient care. There is evolving evidence that will lead to more personalized treatment options for somatic BRCA mutated pancreatic cancer.

Dataset Information

Collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma: A case report.

Introduction and importance

Case presentation

Clinical discussion

Conclusion

Publications

Collision tumor at the rectum consisting of a neuroendocrine carcinoma and adenocarcinoma: A case report.

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