A "one in a million" case of colorectal carcinoma - A case report from a tertiary care centre in Mumbai, India

Abstract

Introduction: Colorectal Carcinoma (CRC) has recently been on the rise among children, bearing a prevalence of 1-2 children/adolescents per million people. Here, we present a rare case of CRC in a 14-year-old male, emphasizing the need for development of better screening techniques to diagnose CRC earlier and with adequate time for intervention.

Case presentation: A 14-year-old male visited our hospital with constipation, intermittent per rectal bleed and dull-aching pain abdomen for 2 months. On per rectal examination, a hard mass was identified, approximately 3 cm above the anal verge. Contrast-enhanced CT (Chest and Abdomen) and MRI Pelvis identified a circumferential thickening in the rectum predominantly involving the anterior rectal wall with effacement of fat planes with the Urinary Bladder without infiltrating it. Colonoscopic biopsy identified Signet Ring Adenocarcinoma. A multi-disciplinary decision was taken to treat him with neoadjuvant chemotherapy and radiotherapy (NACT-RT). MRI Pelvis, post-NACT-RT, showed that the previously- effaced fat plane was now clear and an Abdominoperineal Resection (APR) with permanent end- descending-colostomy was done. Histopathology report of the specimen identified a poorly undifferentiated mucin-secreting adenocarcinoma.

Discussion: At presentation, the patient could have been either planned for extensive surgery or NACT-RT. The choice of NACT-RT was justified in our patient and was advantageous as extensive surgery was prevented.

Conclusion: We implore vigilance in cases of rectal masses due to the rising incidence of CRC among children. We also advocate that there must be no hesitation in subjecting adolescents to Chemotherapy and/or radiotherapy, as the benefits significantly outweigh the risks of with-holding.

Keywords: Colon cancer; Gastrointestinal surgery; General surgery; Paediatric oncology; Surgical oncology.

Fig. 1

MRI Pelvis (pre-NACTRT) - The red arrow points out the effacement of fat planes between the lesion and the Urinary Bladder.

Fig. 2

The black arrow shows the exophytic mass partially occluding the bowel lumen in the anal canal.

Fig. 3

Histopathological study of the specimen clearly showed signet ring cell type of adenocarcinoma.

Fig. 4

MRI pelvis (post-NACTRT) - The red arrow points to the reappearance of free fat planes that were previously effaced between the lesion and the Urinary Bladder.