CARE—Pediatric Colon Adenocarcinoma

Colon carcinoma is a rare disease in the pediatric population. Here is a report on a 17-year-old male adolescent with colon adenocarcinoma who presented with recurrent epigastric colic pain for 1 month. Diagnostic laparoscopic surgery revealed a 3.2 3 cm tumor at the ascending colon, with serosal involvement and peritoneal metastasis. Clinical differences of colorectal carcinoma among children and adults are reviewed and summarized. (Medicine 94(6):e503) Abbreviations: APC = adenomatous polyposis coli, CRC = colorectal carcinoma, CT = computed tomography, DNA = deoxyribonucleic acid, EGFR = epidermal growth factor receptor, ED = emergency department, F = female, FAP = familial adenomatous polyposis, FH = family history, HNPCC = hereditary nonpolyposis colorectal cancer syndrome, M = male, MLH1 = human mutL homolog 1, MSH2 = human mutS homolog 2, MSH6 = human mutS homolog 6, MSI = microsatellite instability, PMS2 = human postmeiotic segregation 2, pTMN = pathologic classification of colorectal cancer staging system by American Joint Committee on Cancer (AJCC), primary tumor (T), status of the regional nodes (N), and distant metastasis (M), UGI = upper gastrointestinal. INTRODUCTION C olorectal carcinoma (CRC) in children, although rarely discovered, comprises approximately 1% of pediatric neoplasms. It is also the most common primary gastrointestinal malignancy in children. However, due to the low awareness of -Hung Huang, MD, and Jia-Uei Wong, MD nonspecific and can mimic those of many benign gastrointestinal conditions in children. However, family history with certain well-documented genetic mutations or inflammatory bowel disease should raise suspicion to the disease. Here is a report that aims to clarify the clinical features and differences between pediatric and adult colon carcinomas. A clearer insight into the disease may help clinicians arrive at an earlier diagnosis for children and adolescents, and consequently, improve overall survival outcome. PRESENTING CONCERNS A 17-year-old male adolescent suffered from recurrent abdominal colic pain for 1 month. The pain was aggravated by walking and partially relieved by bed rest. No referred pain was noted, but associated symptoms were nausea and mildly loose stool. He denied history of tarry or bloody stool. His father had esophageal cancer. CLINICAL FINDINGS Progressive epigastric cramping pain was noted again on the day of admission. There was no fever, vomiting, or diarrhea. Physical examination revealed a distended abdomen with epigastric tenderness. No palpable mass or peritoneal sign was noted. Plain abdomen x-ray showed dilated bowel loops with multiple air-fluid levels (Figure 1A). Intravenous metoclopramide, bisacodyl suppository, and glycerin enema were given but without relief of symptoms. DIAGNOSTIC FOCUS AND ASSESSMENT Abdominal computed tomography (CT) revealed no specific pathologic lesion (Figure 1B–C). Paralytic ileus was the impression. However, there was no clinical improvement even under nil per os and nasogastric decompression. Upper gastrointestinal and small bowel series with water soluble contrast study showed retained contrast media in the small intestine (Figures 1D–F). Mechanical intestinal obstruction was highly suspected. THERAPEUTIC FOCUS AND ASSESSMENT Thus, diagnostic laparoscopy surgery was suggested. An annular colon tumor, about 3.2 3 cm in size, with serosa involvement, was found in the ascending colon (Figure 2A). Frozen biopsy revealed adenocarcinoma. Right hemicolectomy was performed. Several small peritoneal seeding nodules up to 2 mm were also noted (Figure 2C). The final pathology results showed high-grade, poorly differentiated mucinous adenocarcinoma (Figure 3A) with the presence of signet-ring cells ode (6/24) (Figure 3C) and peritoneal confirmed. Final staging was pT4awww.md-journal.com | 1