A Young Boy with Multiple Colorectal Cancers Exhibiting Various Histologies

Abstract

A 11-year-old boy with three colorectal cancers; rectal adenosquamous carcinoma, intramucosal sigmoid colon cancer, and poorly differentiated adenocarcinoma of the transverse colon, entered our hospital. We report this case because both multiple colorectal cancer in people under 20 years old, and rectal adenosquamous carcinoma are rare. Chief complaint of this boy was melena. The first operation was Hartmann's procedure for rectal adenosquamous carcinoma (first cancer). But there was mucinous lymph-node metastasis. A polyp was present on the sigmoid colon which was well differentiated adenocar-cinoma (second cancer). The second operation was drainage for a peri-stomal abscess, and poorly differentiated adenocarcinoma with signet ring cells appeared from the abscess wall. The third operation was resection of the stoma, left hemicolectomy for transverse colon cancer and construction of a transverse colostomy. The transverse colon cancer was poorly differentiated adenocarcinoma with moderate differentiation and mucinous carcinoma (third cancer). Peri-stomal carcinoma was present mainly on the proper muscle layer, and had no connection with the stomal mucosa. The patients is alive now, three years after the first operation, without recurrence. This patient had three colorectal cancers. Peri-stomal cancer seemed to be caused by dissemination from the first cancer during first operation.Synchronous multiple cancers are suspected for these three cancers because of various histologies. Incidentally, adenosquamous carcinoma is thought to result from squamous changes in adenocarcinoma. So we think our patient had cancers of various origins.