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- W2913138833 abstract "Small cell carcinomas (SCC) are rare neuroendocrine malignancies accounting for approximately 0.2% of all colorectal cancers. Since first described in 1955, approximately 200 cases of rectal SCC have been reported in the literature. The most widely accepted theory regarding development of SCC is divergent differentiation of a pluripotent stem cell precursor. Interestingly, although the gastrointestinal tract (GI) has the largest number of neuroendocrine cells, it is rare for neuroendocrine malignancies to originate there. We present a case of metastatic SCC presenting with chief complaint of dyspnea. A 50 year old female with no significant medical history presented to the emergency department with a 2 day history of dyspnea on exertion. She reported two weeks of abdominal bloating, rectal tenesmus, constipation, and unintentional weight loss. Vital signs were notable for hypertension and tachycardia. Labs were notable for alkaline phosphatase 1717 U/L, total bilirubin 2.4 mg/dL, lipase 501 U/L, D-dimer 7.6 μg/mL, WBC 23,900 mCL, Hgb 6.9 gm/dL, and MCV 64.6. CEA was 15.9. CT abdomen and pelvis revealed hepatomegaly with numerous liver lesions (largest in the right lobe measuring 9cm), enlarged intra-abdominal lymph nodes and a perirectal region mass extending to the rectosigmoid measuring 7.5x5x3cm. CT PE protocol demonstrated 2 subcentimeter lung nodules in the right middle lobe. Flexible sigmoidoscopy revealed a mid-rectal mass extending 10cm superiorly. Biopsies revealed small cell neuroendocrine carcinoma with squamous differentiation. Chemotherapy was initiated with carboplatin and etoposide. Small cell carcinomas of the GI tract are exceedingly uncommon. It most commonly presents in the 6th decade of life with male predominance. These tumors exhibit highly aggressive behavior and carry a poor prognosis with a median survival of 10.4 months. Immunohistochemistry differentiates SCC from other malignancies, with strongly positive synaptophysin immunoreactivity the most reliable finding. Due to its histological similarity to small cell lung cancer (SCLC) and rarity, treatment guidelines are extrapolated from SCLC treatment guidelines and include platinum based chemotherapy, radiation and surgical resection. Unfortunately, our patient expired 8 months later due to metastatic disease. This case underscores the importance of histological evaluation of tissue, as treatment often hinges on making an accurate diagnosis.Figure: Synaptophysin IHC confirming neuroendocrine differentiation.Figure: Medium power showing small cell (left) and squamous (right).Figure: Flexible sigmoidoscopy of the upper rectum." @default.
- W2913138833 created "2019-02-21" @default.
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- W2913138833 date "2017-10-01" @default.
- W2913138833 modified "2023-09-27" @default.
- W2913138833 title "Shortness of Breath: An Unusual Presentation of an Uncommon Malignancy" @default.
- W2913138833 doi "https://doi.org/10.14309/00000434-201710001-01446" @default.
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