Clin Endosc.  2012 Mar;45(1):103-107. 10.5946/ce.2012.45.1.103.

A Case of Colonic Mucinous Adenocarcinoma in 19-year-old Male Patient

• Chung MY
• Park YS
• Ryu SR
• Ahn SB
• Kim SH
• Jo YJ
• Han JK
• Joo JE

• KMID: 2048841
• DOI: http://doi.org/10.5946/ce.2012.45.1.103

Abstract

Colorectal cancer is rare in teenagers, especially without known risk factors. Colon cancer in young age is more likely to be diagnosed at advanced-stage, to present unfavorable tumor histology such as mucinous carcinoma, and poor outcome. We report a case of sporadic mucinous adenocarcinoma of the colon in a 19-year-old male patient without any risk factors. He complained of severe left abdominal pain that developed 1 month ago. He had a distended abdomen with severe tenderness on the left lower quadrant. A distal descending colon mass causing mechanical obstruction was observed on abdominal computed tomography. Emergency colonoscopy showed a large, fungating mass obstructing the lumen at 40 cm from the anal verge. Biopsy of the colonic mass suggested a mucinous adenocarcinoma. After decompression by colonic stent, the patient was transferred to the general surgery department for left hemicolectomy. The lesion was confirmed to be a mucinous adenocarcinoma (7.0x4.5 cm). For hereditary nonpolyposis colorectal cancer evaluation, immunohistochemical staining for MLH1 and MSH2 was normal. Reverse transcription polymerase chain reaction analysis did not detect microinstability in any of the markers tested. The patient had no familial history of cancer. Mucinous adenocarcinoma has high frequencies of poor differentiation, advanced tumor stage, loss of mismatch repair gene expression, and increased MUC2 expression. A mucinous histology is considerably more frequent in children and adolescent than in adults. Adequate invasive study is also necessary for young age patients.

Keyword

Mucinous adenocarcinoma; Young age sporadic colorectal cancer

MeSH Terms

Abdomen
Abdominal Pain
Adenocarcinoma, Mucinous
Adolescent
Adult
Biopsy
Child
Colon
Colon, Descending
Colonic Neoplasms
Colonoscopy
Colorectal Neoplasms
Colorectal Neoplasms, Hereditary Nonpolyposis
Decompression
DNA Mismatch Repair
Emergencies
Gene Expression
Humans
Male
Mucins
Polymerase Chain Reaction
Reverse Transcription
Risk Factors
Stents
Young Adult
Mucins

Figure

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  Fig. 1 Radiologic findings. (A) Multiple step-ladder sign is presented. (B) Enhancing mass (red arrow) on distal descending colon. Surrounding soft tissue edema and mechanical obstruction of large bowel are seen.

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  Fig. 2 Colonoscopic findings. (A) Large mass making lumenal obstruction. (B) Gushed out fecal material is seen after stent insertion.

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  Fig. 3 Pathologic fingdings. (A) A circumferential ulceroinfiltrative tumor, 7.0×4.5 cm. (B) Submucosal invasion of mucinous adenocarcinoma can be seen (H&E stain, ×200).

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  Fig. 4 Reverse transcription polymerase chain reaction of microsatellite instability marker shows microsatellite stability.

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  Fig. 5 Pedigree of patient. There is no family history of cancer (black arrow indicates the patient).

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