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Case Reports
. 2015 Oct 8;4(4):399-403.
doi: 10.1016/j.amsu.2015.10.004. eCollection 2015 Dec.

Large cell neuroendocrine - Adenocarcinona mixed tumour of colon: Collision tumour with peculiar behaviour. What do we know about these tumours?

Ana María Minaya-Bravo  1 , Julio Cesar Garcia Mahillo  2 , Fernando Mendoza Moreno  3 , Fernando Noguelares Fraguas  3 , Javier Granell  3
Affiliations
Case Reports

Large cell neuroendocrine - Adenocarcinona mixed tumour of colon: Collision tumour with peculiar behaviour. What do we know about these tumours?

Ana María Minaya-Bravo et al. Ann Med Surg (Lond). .

Abstract

Introduction: Mixed glandular-endocrine carcinomas are rare tumours of gastrointestinal tract (MANEC). They are more frequent in stomach and hardly one hundred cases have been described in colon. According to Lewis, they are classified into collision (side by side pattern), composite (intermingled) or amphicrine (neuroendocrine and glandular features inside a same cell). Collision tumours are related to biclonal theory: two simultaneous cancerogenic events. Conversely, multidirectional differentiation from a stem cell is accepted as origin of composite tumours. The aim of this paper is to analyse the behaviour of these tumours, with an especial concern about how these tumours metastasise, and the different theories about carcinogenesis.

Presentation of case: We report a rare case of collision adenocarcinoma-large cell neuroendocrine tumour of colon that after a three-year period of follow-up has presented a retroperitoneal recurrence that features adenocarcinoma and large cell neuroendocrine components.

Discussion: After an exhaustive review of the English literature, we found that only two cases of collision tumour of colon with metastases showing glandular and endocrine components have been described up to date, so we report the third case, and the first happening in transverse colon.

Conclusion: We conclude that not all collision tumours follow the biclonal theory and more studies are needed to clarify the origin of these neoplasms, and consequently, to reach an adequate treatment.

Keywords: Collision; Colon; Composite; MANEC; Mixed; Tumour.

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Figures

Fig. 1
Fig. 1
Contrast enhanced CT showed an irregular circumferential mass in the left half of transverse colon with fat stranding adjacent to thickened bowel wall.
Fig. 2
Fig. 2
Large cell neuroendocrine carcinoma, positive for Chromogranin A, and moderately differentiated adenocarcinoma in a collision pattern.
Fig. 3
Fig. 3
CT demonstrated a retroperitoneal mass surrounding the left lumbar urether and causing ureterohydronefrosis: A and B. This lesion was suggestive of recurrence: C.
Fig. 4
Fig. 4
Recurrence retroperitoneal mass with a size of 2 × 2 cm size composed of adenocarcinoma and neuroendocrine (GIII). Immunohistochemical study revealed neuroendocrine cells positive for chromogranin A (A and B). Hematoxylin eosin staining showed glandular component (C and D).
See this image and copyright information in PMC

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