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. 2019:65:313-316.
doi: 10.1016/j.ijscr.2019.10.071. Epub 2019 Nov 4.

Paneth cell adenocarcinoma of the colon: A rare entity

Abdessayed Nihed  1 , Mrabet Soumaya  2 , Baccouche Atika  3 , Ben Jazia Ilhem  2 , Ben Abdelkader Atef  3 , Hmila Fehmi  4 , Mokni Moncef  5
Affiliations

Paneth cell adenocarcinoma of the colon: A rare entity

Abdessayed Nihed et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Amongst the morphotypes of colorectal adenocarcinomas, the rich cell type of Paneth constitutes a rare histopathologic variant of adenocarcinoma, which can be observed all along the digestive tract but also in other organs such as the prostate or the breast. About 24 cases were found in the literature, with only 7 cases within the colon and appendix.

Presentation of case: We report the case of a 50-year-old man, without past medical history, complaining of abdominal pain and constipation for 3 months. Biological tests were normal. Radiological investigations and endoscopy revealed a sessile polyp in the right colonic angle measuring 4 cm in greatest diameter. Biopsy concluded to a tubular adenoma with low-grade dysplasia. The patient underwent right hemicolectomy. Microscopically, an invasive adenocarcinoma was identified occupying the colonic mucosal with an invasion of the submucosa. The tumor showed a tubulovillous pattern on the surface and was made mostly of jagged crowded glands in the depth. Some areas exhibit Paneth cell differentiation. No metastatic lymph node was found, and the tumor was staged T1N0. The postoperative course was uneventful. The patient remained free of symptoms at the 6-month follow-up and had no evidence of recurrence.

Conclusion: We reported a Tunisian case of Paneth cell colonic adenocarcinoma. The diagnosis is challenging in biopsies when only well-differentiated areas are sampled. Lysozyme immune-histochemical stain may be helpful when diagnosis difficulty arises. The beta-catenin pathway seems to be activated. More studies are needed for the etiology, pathogenesis, clinical course, prognosis and treatment of Paneth cell carcinoma.

Keywords: Adenocarcinoma; Beta-catenin; Cell; Colonic; Paneth; Pathogenic.

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Figures

Fig. 1
Fig. 1
Abdominal CT scan showing a polypoid mass (⇆) in the right colon.
Fig. 2
Fig. 2
Macroscopic examination of polypoid mass (⇆) with white color and large base of implantation.
Fig. 3
Fig. 3
Microscopic finding of the tumor, showing a carcinomatous proliferation well differentiated raising in a high grade adenoma with invasion of submucosa (⇆) (HEx100).
Fig. 4
Fig. 4
High-power magnification showing crowded tumoral glands of intestinal type with Paneth cell component (HEx200).
Fig. 5
Fig. 5
Nuclear b catenin staining at immunochemistry. (IHCx100).
See this image and copyright information in PMC

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