Familial adenomatous polyposis with synchronous invasive colonic carcinomas and metastatic jejunal adenocarcinoma in a Nigerian male

Abstract

Familial adenomatous polyposis is rare. Three cases were previously reported in Nigeria. An intriguing feature of this case is an ulcerated jejunal carcinoma which was metastatic rather than synchronous carcinoma. This patient presented with partial large bowel obstruction and the pathological analysis revealed 4 invasive adenocarcinomas, 3 in the colon and 1 in the jejunum (Dukes stage D). Palliative pancolectomy and jejunal tumour resection with chemotherapy was offered to him. He died eight months after surgery from disease progression. The challenges of managing a hereditary cancer syndrome in a resource poor country are highlighted.

Keywords: adenocarcinoma.; colon; familial adenomatous polyposis; jejunum.

Figure 1

Colectomy specimen showing nodular metastatic masses in the mesentery (yellow arrows), 3 invasive carcinomas on the colonic wall (black arrows), multiple sessile (not indicated by arrows), and a pedunculated (white arrow) adenomatous polyps with mild to moderate dysplasia

Figure 2

The colonic wall is shown with an 2 invasive ulcerated adenocarcinomas (yellow arrows), one of which is annular and stenoses the intestinal lumen (horizontal yellow arrow). Metastatic nodular masses are seen in the mesentery surrounded by whitish capsules.

Figure 3

The jejunum is seen with an invasive ulcerated adenocarcinoma. The tumour extends to the subserosal fat but not the serosa. Mass shows whitish tumor growing from the subserosal fat towards the mucosa with elevation of the muscularis propria.

Figure 4

The first colonic adenocarcinoma (Tumour-1) is shown. Note the irregular invasive tumour glands and cord extending into the wall of the colon.

Figure 5

The second colonic adenocarcinoma (Tumour-2) is shown. Note the irregular invasive tumour glands and cords extending beyond the muscularis propia of the wall (right side) into the subserosal tissue.

Figure 6

The third colonic adenocarcinoma (Tumour-3) is shown with irregular invasive tumour glands and cords in the mucosa (right side) and submucosa (left side).

Figure 7

The metastatic adenocarcinoma (Tumour-4) is seen as irregular glands and cords in the submucosa and muscularis propia of the jejunum.

Figure 8

One of the metastatic nodules in the mesentery is shown with similar appearing irregular invasive tumour glands and cords.

Figure 9

The pedunculated polyp is shown with villous structures lined by tall epithelial cells. The is no stromal invasion.

Figure 10

One of the sessile polyps is shown with tubular structures lined by epithelium demonstrating decreased mucin secretion and nuclear pseudostratification with conservation of polarity - moderate dysplasia.