Microscopically, the pathological result was chronic inflammation of the mucous membrane in superficial erosion. The residual colorectal mucosa is characterized by hyperemia and edema ( Figure 1A,B). The mass contained a friable and ulcerated lesion, and it bled easily when touched. The serum levels of epithelial tumor markers, such as carbohydrate antigen 19-9 (CA19-9 133.70 U/mL) and carcinoembryonic antigen (CEA 7.62 ng/mL) were exceeding the normal limit, and fecal occult blood (OB) was also positive.ĭuring the endoscopic procedure, it was available to explore the gut from the anus to the hepatic flexure of transverse colon (70 cm from the anal margin), where a tight stenosis blocking the endoscopic passage was found with a hemicircumferential mass in the ascending colon. Laboratory examinations showed a hemoglobin 10.6 g/dL, white blood cell (WBC) 14.21×10 3/mm 3, Neutrophil (Neu) 12.75×10 3/mm 3. Upon physical examination, direct tenderness in the navel and the lower abdomen is positive, accompanied by abdominal distension. Her past medical and family history was noncontributory.
She was hospitalized for large bowel obstruction syndrome. We present the following article in accordance with the CARE reporting checklist (available at ).Ī 46-year-old female experienced a history of abdominal pains and hematochezia for more than twenty days, and visited the emergency room with increasing abdominal pain and vomiting for nearly one day. Here, we presented a 46-year-old woman diagnosed as colon ASC through computed tomography (CT) scan and endoscopic examination with abdominal pain and hematochezia for more than 20 days, which was consistently confirmed by pathological examinations of surgical specimen. Surgical resection remains the primary therapy for colorectal ASC, and the prognosis of adenosquamous colon cancer is poorer than AC alone ( 5). Clinical manifestations are similar to colorectal ACs, and the diagnosis is based primarily on histologic examination ( 4). It was described as a cancer containing both adenocarcinoma (AC) and squamous cell carcinoma (SCC) component ( 3). Primary adenosquamous carcinoma (ASC) of the colon is extremely rare entities ( 1), of which the incidence is around 0.06% of all colorectal cancers ( 2). Accepted for publication Mar 24, 2021.Ĭolorectal cancer is the third most common cancer globally. Keywords: Colorectal cancer adenosquamous carcinoma (ASC) hepatic flexure of colon case report This case promotes the understanding of colon ASC and provides a basis for its clinical diagnosis and treatment. In conclusion, radical resection remains the major treatment for colon ASC, CT scan and endoscopic examination and biopsy are useful for this pre-operative diagnosis. Accordingly, this case was diagnosed as ASC of Stage IIIC (pT4N2M0) and the adjuvant chemotherapy FOLFOX was recommended, while unfortunately the patient refused it for personal reasons. The post-operative pathological examination demonstrated that the tumor was composed of AC (positive for CDX-2 and CK20) and SCC (positive for CK5/6 and P63) components. Furthermore, the multidisciplinary team (MDT) meeting thought laparoscopic right colectomy accompanied with lymphadenectomy was suitable because the clinical stage was at least stage IIIB. Abdominal computed tomography (CT) scanning showed some signs of neoplastic lesion that the wall of the hepatic curvature of the transverse colon is irregularly thicker, the serous surface of the diseased intestinal canal is slightly thicker, and multiple peripheral lymph nodes are enlarged.
Results of biopsy suggested a high-grade intraepithelial neoplasia. Then endoscopic examination revealed a hemicircumferential mass in the ascending colon, which contained a friable and ulcerated lesion that bled easily when touched. Laboratory examinations showed a decreased hemoglobin, increased white blood cell (WBC) count, an elevation of the serum levels of CA19-9 and carcinoembryonic antigen (CEA). Physical examination indicated direct tenderness in the navel and lower abdomen distension. Here, we reported that a 46-year-old woman was caught by abdominal pain and hematochezia for more than 20 days and she visited the emergency room with increasing abdominal pain and vomiting for nearly one day. To date, only few cases were recorded previously.
ASC is more aggressive for resulting in a poorer prognosis than AC alone. Abstract: Adenosquamous carcinoma (ASC) is defined as a very rare subset of colorectal cancer containing both adenocarcinoma (AC) and squamous cell carcinoma (SCC) components.
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