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• W2977448831 abstract "Neuroendocrine carcinomas of the colon and rectum are very aggressive neoplasms that carry a poor prognosis, by the time diagnosis is made distant metastases are often present. A 65 year old male presented to his PCP with a chief complaint of persistent right-sided abdominal pain, nausea, vomiting, loose stools and a 20 pounds weight loss over the previous month. His medical history was relevant for adenomatous polyps found on screening colonoscopy in 2005, follow-up colonoscopies were normal in 2006 and 2009. Examination revealed the presence of a cylindrical mass in the right lower quadrant of the abdomen. No guarding or other signs of acute abdomen were appreciated. CT imaging revealed the presence of a cecal mass 7.5 x 5.2 x 3.5 cm, innumerable hepatic hypodensities, necrotic mesenteric and retroperitoneal lymph nodes and appendiceal inflammation. Colonoscopy performed on hospital day 2 revealed an exophytic mass extending from the proximal ascending colon to the cecum and occupying approximately 75% of the luminal circumference. Biopsies showed the presence of a high grade, poorly differentiated neuroendocrine tumor with elements of adenocarcinoma. The neuroendocrine portion of the tumor stained positive for synaptophysin but negative for chromogranin A. Ki-67 immunostaining showed 80% proliferation index and mitotic count of 16 per 7 HPF (Image 1). Carcinoembryonic antigen and alpha-fetoprotein levels were within normal limits however cancer antigen 19-9 was elevated. Non-curative surgical resection of the tumor prior to initiation of chemotherapy was done in order to prevent obstruction during chemotherapy; after the first cycle of chemotherapy with irinotecan + cisplatin, restaging showed progression of disease. However, the patient decompensated developing sepsis and passed away two months after diagnosis was made. As this case highlights, poorly differentiated neuroendocrine carcinomas are aggressive and prognosis is discouraging despite treatment. Our patient sought medical care one month after symptoms developed. Despite adequate colon cancer screening and surveillance, and even with prompt medical intervention at the time of diagnosis, the management and treatment offered were palliative and not curative. Treatment options are evolving and multiple studies using everolimus and other therapies are ongoing. However, pending further investigations, it is important to keep in mind that involving palliative care early may be necessary.Figure 1" @default.
• W2977448831 created "2019-10-10" @default.
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• W2977448831 date "2016-10-01" @default.
• W2977448831 modified "2023-09-27" @default.
• W2977448831 title "Neuroendocrine Carcinoma of the Cecum: Inevitable Progression?" @default.
• W2977448831 doi "https://doi.org/10.14309/00000434-201610001-01347" @default.
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