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Gonzalez RS, Horton RK, Zhang X, Graham RP, Longacre TA, Mehrotra A, Allende DS, McHugh KE, Shia J, Westerhoff M, Srivastava A, Chen W, Vazzano J, Swanson PE, Chatterjee D, Cheema H, Ma C, Mannan R, Chetty R, Nowak KM, Serra S, Agostini-Vulaj D, Kazemimood R, Henn P, Kakar S, Choi WT, Adeyi O, Jenkins SM, Nagtegaal ID. Colorectal adenosquamous carcinoma: clinicopathologic analysis of two large cohorts and literature review confirm poor prognosis and reveal prognostic aspects. Histopathology 2025; 86:1064-1081. [PMID: 39887413 DOI: 10.1111/his.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 12/20/2024] [Accepted: 01/02/2025] [Indexed: 02/01/2025]
Abstract
AIMS We compiled two cohorts of colorectal adenosquamous carcinoma (ASC) to describe its histologic and molecular aspects using modern parameters to compare them with literature reports using meta-analysis of cohorts and individual case series. METHODS AND RESULTS We identified 53 colorectal ASC from 19 North American academic medical centres, in addition to national database reports on 94 Dutch cases. We analysed available clinical, histologic, and immunohistochemical features and patient outcome. ASC comprised 0.02% of colorectal cancers in the Dutch database. The median cohort patient ages at resection were 65 and 69 years (North American and Dutch cohorts, respectively), with a roughly equal male:female ratio. The squamous component represented between 5% and 95% of each tumour, with a median of 50%. Tumour-infiltrating lymphocytes (TILs) were generally low (66%), and tumour budding was often Bd1 (64%). Most cases were pT3 (55%) or pT4 (40%), with nodal metastases in more than half (58%). Twenty-three cases (43%) metastasized distantly, most commonly to the liver. Mismatch repair (MMR) deficiency was identified in 34% of the cases. Follow-up was available for 48 patients; 13 (27%) had recurrent disease and 29 (60%) died. A total of 31 patients progressed, with median time to progression of 18 months. Available data for the Dutch cohort revealed largely similar findings, as did review of cases in the literature. CONCLUSION Colorectal ASC usually presents at an advanced stage. Despite high rates of MMR deficiency and low tumour budding, TILs were generally low, and there is a high recurrence rate and poor prognosis.
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Affiliation(s)
- Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, USA
| | | | - Xuchen Zhang
- Department of Pathology, Yale University, New Haven, CT, USA
| | | | - Teri A Longacre
- Department of Pathology, Stanford University, Stanford, CA, USA
| | | | | | - Kelsey E McHugh
- Department of Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Amitabh Srivastava
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Wei Chen
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Jennifer Vazzano
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Paul E Swanson
- Department of Pathology, University of Washington, Seattle, WA, USA
| | | | - Hassam Cheema
- Department of Pathology, Washington University in St. Louis, St. Louis, MO, USA
| | - Changqing Ma
- Department of Pathology, Washington University in St. Louis, St. Louis, MO, USA
| | - Rifat Mannan
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Runjan Chetty
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - Klaudia M Nowak
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - Stefano Serra
- Department of Pathology, University Health Network, Toronto, ON, Canada
| | - Diana Agostini-Vulaj
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Patrick Henn
- Department of Pathology, University of Colorado, Aurora, CO, USA
| | - Sanjay Kakar
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Won-Tak Choi
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Oyedele Adeyi
- Department of Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
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Minami R, Kimura M, Nishikawa K, Imamura J, Kimura K. Clinical Outcomes of Hepatic Squamous Cell Carcinoma With Fibroblast Growth Factor Receptor 2 (FGFR2) Mutation: A Case Report. Cureus 2025; 17:e78024. [PMID: 40013221 PMCID: PMC11861221 DOI: 10.7759/cureus.78024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2025] [Indexed: 02/28/2025] Open
Abstract
Primary squamous cell carcinoma of the liver (PSCCL) is an extremely rare disease with a poor prognosis. To date, few cancer-related genetic abnormalities in PSCCL have been reported. This report describes a case of PSCCL with FGFR2 alterations in a male patient in his 50s. The patient presented with loss of appetite and epigastric pain. Computed tomography confirmed an irregular mass in the liver and lymphadenopathy in the mediastinum and right supraclavicular region. Biopsies were obtained from the liver and right supraclavicular lymph nodes, and a diagnosis of squamous cell carcinoma was determined. No other primary lesions were identified, and PSCCL was diagnosed. Administration of gemcitabine + cisplatin and gemcitabine + S-1 was discontinued due to allergic reactions. Erdafitinib was then administered; however, the disease progressed. The patient passed away 12 months after the initial treatment. No established treatment options for PSCCL are currently available. Identifying cancer-related genetic abnormalities may help in making treatment decisions.
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Affiliation(s)
- Ryogo Minami
- Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, JPN
| | - Masamichi Kimura
- Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, JPN
| | - Koji Nishikawa
- Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, JPN
| | - Jun Imamura
- Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, JPN
| | - Kiminori Kimura
- Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, JPN
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Larkins MC, Bhatt A, Irish W, Kennedy KN, Burke A, Armel K, Honaker MD. Squamous cell carcinoma of the colon: evaluation of treatment modalities and survival. J Gastrointest Surg 2024; 28:1122-1125. [PMID: 38723998 DOI: 10.1016/j.gassur.2024.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Squamous cell carcinoma of the colon (CSCC) is a rare subtype of colon cancer. This study aimed to evaluate treatment strategies and overall survival (OS). METHODS Using the Surveillance, Epidemiology, and End Results program database from 2008 to 2019, patients aged 18 years with CSCC were identified. Treatment strategies and OS were summarized using the Kaplan-Meier analysis and the log-rank test. Adjusted Cox proportional hazards regression model ratios were calculated to evaluate the effect of confounding variables. RESULTS After exclusions, 153 patients met the inclusion criteria. The most common treatment modalities included surgery alone (52.1%), surgery and adjuvant chemotherapy (12.9%), and no treatment (26.4%). Kaplan-Meier analysis revealed that patients who underwent surgery and adjuvant chemotherapy had significant improvements in OS (log-rank P = .002). Cox regression analysis revealed tumor grade (hazard ratio [HR], 2.12; 95% CI, 1.17-3.86) and receipt of chemotherapy (HR, 2.66; 95% CI, 1.23-5.76) as the only factors associated with improvements in OS. CONCLUSION Patients who underwent surgery in combination with chemotherapy had better OS than those who underwent surgery alone. Tumor grade and receipt of chemotherapy were independently associated with OS.
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Affiliation(s)
- Michael C Larkins
- Brody School of Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina, United States
| | - Arjun Bhatt
- Brody School of Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina, United States
| | - William Irish
- Division of Surgical Research, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, United States
| | - Katie N Kennedy
- Department of Hematology and Oncology, East Carolina University Brody School of Medicine, Greenville, North Carolina, United States
| | - Aidan Burke
- Department of Radiation Oncology, East Carolina University Brody School of Medicine, Greenville, North Carolina, United States
| | - Kristen Armel
- Brody School of Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina, United States
| | - Michael D Honaker
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, United States.
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Obstructing primary squamous cell carcinoma of caecum: A case report. Ann Med Surg (Lond) 2022; 78:103907. [PMID: 35734702 PMCID: PMC9207086 DOI: 10.1016/j.amsu.2022.103907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the colon is a rare malignancy and usually a pathological surprise. Clinical presentation is usually very similar to adeno carcinoma variety. We report a case of a 56 year old male with primary SCC of caecum presenting as small bowel obstruction and managed with surgery and adjuvant chemotherapy. It was labelled as primary SCC after extensive search for other primary malignant SCC in body with possible metastasis to caecum. Due to rarity of the disease and lack of literature standardized protocols for neo-adjuvant and adjuvant therapy are not available.
Primary squamous cell carcinoma colon-a rare entity. Usually a pathological surprise. Very similar presentations like adeno counterpart. Metastasis from other sites must be ruled out. Treatment not standardized yet.
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Khan AH, Gao X, Goffredo P, Kahl AR, Utria AF, Charlton ME, Ahad S, Hassan I. Presentation, treatment, and prognosis of colorectal adenosquamous carcinoma: A contemporary analysis of the surveillance, epidemiology, and end results database. Am J Surg 2021; 223:957-962. [PMID: 34530984 DOI: 10.1016/j.amjsurg.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Colorectal adenosquamous carcinoma (ASC) represents <0.1% of colorectal cancers. Due to its rarity, there is paucity of data regarding its prognosis and treatment compared to other colorectal cancers. The aim of the study was to evaluate presentation, treatment and prognosis of colorectal ASC in comparison to adenocarcinoma (AC) and squamous cell carcinoma (SCC). METHODS Adult patients diagnosed with colorectal AC, SCC, and ASC between 2000 and 2017 were identified using Surveillance, Epidemiology, and End Results database. RESULTS Among the 446,132 patients diagnosed with colorectal cancer, 0.06% had ASC and were more likely to present with higher T stage and distant metastases compared to AC and SCC (p < 0.001). Major surgery was the primary treatment for colonic ASC, while for rectal ASC, chemotherapy and/or radiation were mainly utilized. Localized and distant colonic ASC had an unadjusted 5-year cause-specific survival that was worse than AC, while rectal ASC had the worst survival across all stages. CONCLUSION Colorectal ASC usually present with advanced stage and have overall worse prognosis. Standardization of treatment strategies may improve survival in colorectal ASC.
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Affiliation(s)
- Adil H Khan
- Raleigh General Hospital, 1710 Harper Road, Beckley, WV, 25801, USA.
| | - Xiang Gao
- Department of Surgery, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Paolo Goffredo
- Department of Surgery, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Amanda R Kahl
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA, 52242, USA.
| | - Alan F Utria
- Department of Surgery, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Mary E Charlton
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Dr., Iowa City, IA, 52242, USA.
| | - Sajida Ahad
- Department of Surgery, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
| | - Imran Hassan
- Department of Surgery, University of Iowa, 200 Hawkins Dr., Iowa City, IA, 52242, USA.
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Ali Husain AH, Kaundinya KB, Hammed F, Al Sayed AR. The surprise pathology-Primary squamous cell carcinoma of the colon-A case report. Int J Surg Case Rep 2020; 72:75-78. [PMID: 32516701 PMCID: PMC7283961 DOI: 10.1016/j.ijscr.2020.05.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/14/2020] [Accepted: 05/22/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Primary squamous cell carcinomas are rare in the colon. Identified as colonic growths causing obstructive or ulcerative features, they are treated like usual colonic adenocarcinomas until the surprise findings on histopathology. A thorough search for possible primary with colonic metastasis is warranted prior to confirmation of diagnosis. They can coexist with adenocarcinomas and ulcerative colitis. We present this case with intent to add to existing literature the presentation and catastrophic clinical course of the disease in our patient. CLINICAL FINDINGS The patient presented with obstructive pattern of a colonic growth with rapid weight loss. There was no family history of colonic disease and the patient did not suffer from inflammatory bowel disease. DIAGNOSIS AND THERAPEUTIC INTERVENTION CT Scan of the abdomen revealed the growth which was infiltrating the abdominal musculature causing micro abscess formation. Colonoscopy was inconclusive as the growth was not passable enough to obtain enough biopsy for pathology. The patient underwent surgery for removal of tumor and the histopathology revealed the squamous cell carcinoma. Through the course of patient's recovery in hospital thorough evaluation was done to identify primary in sites mainly the urogenital tract. The patient was discharged and unfortunately succumbed to her disease at home before definitive treatment could be given. CONCLUSION Squamous cell carcinomas in the colon warrants extensive search for the primary and coexistent adenocarcinomas or ulcerative colitis. In patients who recover from surgery, chemoradiation directed towards the pathology should be initiated to prevent rapid deterioration as in our case. Its presentation may be exophytic infiltrating surrounding structures and micro abscesses or perforations may also be encountered. We add our case report to the existing literature of primary squamous cell colon carcinoma series.
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Comparison of Anal Versus Rectal Staging in the Prognostication of Rectal Squamous Cell Carcinoma: A Population-Based Analysis. Dis Colon Rectum 2019; 62:302-308. [PMID: 30398999 DOI: 10.1097/dcr.0000000000001205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Rectal squamous cell carcinoma is a rare malignancy with limited data regarding management and prognosis. It is also unknown whether a rectal squamous cell cancer staging system should be based on size, as for anal squamous cell carcinoma, or depth of invasion, as for rectal adenocarcinoma. OBJECTIVE The aims of the current study were to determine the optimal management strategy, prognostic factors, and staging system for rectal squamous cell carcinoma. DESIGN This was a population-based study. SETTINGS The Surveillance, Epidemiology, and End Results database was used to identify patents diagnosed between 1988 and 2013. PATIENTS Patients ≥18 years of age undergoing radiation or local excision alone, radiation with local excision, or radiation with radical resection were included. Patients were then staged according to both the American Joint Committee on Cancer classification for rectal adenocarcinoma (American Joint Committee on Cancer-rectum) and anal cancer (American Joint Committee on Cancer-anus). MAIN OUTCOME MEASURES The main outcome was 5-year, disease-specific survival. RESULTS In both univariate and multivariate survival analyses, the addition of local excision or radical resection to radiation resulted in similar-to-worse outcomes across all of the stages. Among patients staged according to American Joint Committee on Cancer-rectum (n = 1646), although a significant difference in 5-year survival was observed for stage I as compared with higher stages, no difference was noted between stages II and III (80% vs 61% and 62%). However, in the American Joint Committee on Cancer-anus classification (n = 1327), a significant difference was observed across all of the stages (87% vs 72% vs 59%; p < 0.001). In multivariate analysis, the prognostic discrimination based on HRs provided by the American Joint Committee on Cancer-anus was superior to that of the American Joint Committee on Cancer-rectum. LIMITATIONS This study was limited by lack of data on chemotherapy and location of positive nodes. CONCLUSIONS A treatment approach primarily based on radiation should be considered the optimal management strategy for rectal squamous cell carcinoma. Moreover, a staging system based on size (American Joint Committee on Cancer-anus) rather than on depth of invasion (American Joint Committee on Cancer-rectum) appears to be more accurate in predicting its prognosis. See Video Abstract at http://links.lww.com/DCR/A734.
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8
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Dikshit V, Ali I, Patil C, Manerikar K, Mody P. Squamous Cell Carcinoma of Colon-an Etiopathological Surprise. J Gastrointest Cancer 2018; 50:604-608. [PMID: 29417382 DOI: 10.1007/s12029-018-0072-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Vashisht Dikshit
- Department of Surgery, Dr. D. Y. Patil Medical College and Hospital, Sant Tukaram Nagar, Pimpri, Pune, 411018, India.
| | - Iqbal Ali
- Department of Surgery, Dr. D. Y. Patil Medical College and Hospital, Sant Tukaram Nagar, Pimpri, Pune, 411018, India
| | - Chandradip Patil
- Department of Surgery, Dr. D. Y. Patil Medical College and Hospital, Sant Tukaram Nagar, Pimpri, Pune, 411018, India
| | - Kshitij Manerikar
- Department of Surgery, Dr. D. Y. Patil Medical College and Hospital, Sant Tukaram Nagar, Pimpri, Pune, 411018, India
| | - Pratham Mody
- Department of Surgery, Dr. D. Y. Patil Medical College and Hospital, Sant Tukaram Nagar, Pimpri, Pune, 411018, India
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Abstract
OBJECTIVES Squamous cell carcinoma (SCC) of the rectum is a rare disease with <80 cases reported in the English literature. We reviewed outcomes in patients with SCC of the rectum treated with definitive chemoradiation at a single institution. MATERIALS AND METHODS We identified 14 patients treated definitively with chemoradiation for SCC of the rectum. All patients were female and the median age was 56 years at presentation. Patients were treated with external beam radiation therapy with a median dose of 54 Gy (range, 38 to 58.8 Gy). All patients received concurrent chemotherapy, with 5-flourouracil and cisplatin in 10 patients and capecitabine and cisplatin in 4 patients. RESULTS The median follow-up was 4.5 years (range, 1.8 to 16.3 y). Only 3 of the 14 patients had relapse or persistent disease, and 2 of these underwent successful salvage surgery. The remaining 11 patients had no evidence for local or distant relapse after chemoradiation. Only 1 patient died of SCC of the rectum, 1 died of a second primary, and 12 are alive with no evidence of disease. The 5-year actuarial overall survival, disease-free survival, and disease-specific survival rates were 81%, 72%, and 88% respectively. CONCLUSIONS Chemoradiation is an ideal strategy for definitive therapy of SCC of the rectum with excellent disease-free survival and overall survival. In patients with local failure, salvage surgery can provide excellent outcomes.
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10
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Ishida H, Yamaguchi T, Chiba K, Iijima T, Horiguchi SI. A case report of ascending colon adenosquamous carcinoma with BRAF V600E mutation. Int Cancer Conf J 2017; 6:93-97. [PMID: 31149479 DOI: 10.1007/s13691-017-0283-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/06/2017] [Indexed: 12/23/2022] Open
Abstract
A 78-year-old Japanese male was referred to our hospital with a 3-month history of anorexia and right abdominal pain. A colonoscopy showed circumferential narrowing of the ascending colon with deep ulceration. Biopsy was performed, and examination of the specimen demonstrated squamous cell carcinoma. Abdominal computed tomography demonstrated thickening of the wall of the ascending colon, multiple lymph node metastases, multiple liver metastases, and peritoneal dissemination. After right hemicolectomy, histological examination demonstrated adenosquamous carcinoma. Biomarker analysis showed a microsatellite stable, wild-type KRAS gene in exon 2 and BRAF V600E mutation. Despite undergoing intensive chemotherapy, the patient died 5 months postoperatively.
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Affiliation(s)
- Hiroyuki Ishida
- 1Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677 Japan
| | - Tatsuro Yamaguchi
- 1Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677 Japan.,2Hereditary Tumor Research Project, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- 3Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Takeru Iijima
- 2Hereditary Tumor Research Project, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Shin-Ichiro Horiguchi
- 4Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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11
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Zhao S, Guo J, Sun L, Lv J, Qiu W. Gemcitabine-based chemotherapy in colon squamous cell carcinoma: A case report and literature review. Mol Clin Oncol 2017; 6:561-565. [PMID: 28413669 DOI: 10.3892/mco.2017.1178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/17/2017] [Indexed: 12/15/2022] Open
Abstract
Squamous cell carcinoma (SCC) originating from the colon is rare. In terms of its clinicopathological characteristics, this type of cancer has been reported to be more aggressive and have a worse prognosis compared with adenocarcinoma. We herein present a successful therapeutic approach applying neoadjuvant and adjuvant gemcitabine-based chemotherapy in a patient with colon SCC. A 58-year-old male patient received two cycles of neoadjuvant chemotherapy with a regimen including gemcitabine, oxaliplatin and capecitabine, followed by radical excision and six cycles of adjuvant chemotherapy. Contrast-enhanced computed tomography and serum tumor markers were used for reassessment and evaluation was based on the World Health Organization criteria. Following neoadjuvant chemotherapy, the mass had shrunk and the patient was classed as having stable disease. Surgery and adjuvant chemotherapy were then performed and the patient had achieved a progression-free survival of 10 months when this report was submitted. Therefore, gemcitabine may be a treatment option for colon SCC in the neoadjuvant and/or adjuvant chemotherapy setting.
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Affiliation(s)
- Shufen Zhao
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Jing Guo
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Libin Sun
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Jing Lv
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Wensheng Qiu
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
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Rami S, Han YD, Jang M, Cho MS, Hur H, Min BS, Lee KY, Kim NK. Efficacy of Immunohistochemical Staining in Differentiating a Squamous Cell Carcinoma in Poorly Differentiated Rectal Cancer: Two Case Reports. Ann Coloproctol 2016; 32:150-5. [PMID: 27626026 PMCID: PMC5019968 DOI: 10.3393/ac.2016.32.4.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/16/2016] [Indexed: 11/17/2022] Open
Abstract
A rectal carcinoma, including primary an adenosquamous and a squamous cell carcinoma (SCC), is a very rare disease, accounting for 0.025% to 0.20% of all large-bowel malignant tumors. Because SCCs have a higher mortality than adenosquamous carcinomas, determining whether the primary rectal cancer exhibits an adenomatous component or a squamous component is important. While differentiating between these 2 components, especially in poorly differentiated rectal cancer, is difficult, specific immunohistochemical stains enable accurate diagnoses. Here, we report the use of immunohistochemical stains to distinguish between the adenomatous and the squamous components in 2 patients with low rectal cancer, a 58-year-old man and a 73-year-old woman, who were initially diagnosed using the histopathologic results for a poorly differentiated carcinoma. These data suggest that using these immunohistochemical stains will help to accurately diagnose the type of rectal cancer, especially for poorly differentiated carcinomas, and will provide important information to determine the proper treatment for the patient.
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Affiliation(s)
- Sairafi Rami
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Dae Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jang
- Department of Clinical Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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13
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Guerra GR, Kong CH, Warrier SK, Lynch AC, Heriot AG, Ngan SY. Primary squamous cell carcinoma of the rectum: An update and implications for treatment. World J Gastrointest Surg 2016; 8:252-265. [PMID: 27022453 PMCID: PMC4807327 DOI: 10.4240/wjgs.v8.i3.252] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/03/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To provide an update on the aetiology, pathogenesis, diagnosis, staging and management of rectal squamous cell carcinoma (SCC).
METHODS: A systematic review was conducted according to the preferred reporting items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE was performed with the reference list of selected articles reviewed to ensure all relevant publications were captured. The search strategy was limited to the English language, spanning from 1946 to 2015. A qualitative analysis was undertaken examining patient demographics, clinical presentation, diagnosis, staging, treatment and outcome. The quantitaive analysis was limited to data extracted on treatment and outcomes including radiological, clinical and pathological complete response where available. The narrative and quantitative review were synthesised in concert.
RESULTS: The search identified 487 articles in total with 79 included in the qualitative review. The quantitative analysis involved 63 articles, consisting of 43 case reports and 20 case series with a total of 142 individual cases. The underlying pathogenesis of rectal SCC while unclear, continues to be defined, with increasing evidence of a metaplasia-dysplasia-carcinoma sequence and a possible role for human papilloma virus in this progression. The presentation is similar to rectal adenocarcinoma, with a diagnosis confirmed by endoscopic biopsy. Many presumed rectal SCC’s are in fact an extension of an anal SCC, and cytokeratin markers are a useful adjunct in this distinction. Staging is most accurately reflected by the tumour-node-metastasis classification for rectal adenocarcinoma. It involves examining locoregional disease by way of magnetic resonance imaging and/or endorectal ultrasound, with systemic spread excluded by way of computed tomography. Positron emission tomography is integral in the workup to exclude an external site of primary SCC with metastasis to the rectum. While the optimal treatment remains as yet undefined, recent studies have demonstrated a global shift away from surgery towards definitive chemoradiotherapy as primary treatment. Pooled overall survival was calculated to be 86% in patients managed with chemoradiation compared with 48% for those treated traditionally with surgery. Furthermore, local recurrence and metastatic rates were 25% vs 10% and 30% vs 13% for the chemoradiation vs conventional treatment cohorts.
CONCLUSION: The changing paradigm in the treatment of rectal SCC holds great promise for improved outcomes in this rare disease.
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Abstract
Basaloid squamous cell carcinoma (BSCC) of the colon is rarely found proximal to the anal canal. We report a case of an 81-year-old woman who was diagnosed with squamous cell carcinoma (SCC) of the lung without metastasis and BSCC of the sigmoid with differing histologic findings suggesting that these tumors were separate primary neoplasms. SCC of the colon has a dismal prognosis. Surgery is the primary method of treatment when feasible, in addition to chemotherapeutic agents.
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15
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Funahashi K, Nemoto T, Koike J, Kurihara A, Shiokawa H, Ushigome M, Kaneko T, Arai K, Nagashima Y, Koda T, Suzuki T, Kagami S, Suitsu Y, Kaneko H, Shibuya T. Chemoradiation therapy with S-1 for primary squamous cell carcinoma of the rectum: report of three cases. Surg Case Rep 2015; 1:14. [PMID: 26943382 PMCID: PMC4747969 DOI: 10.1186/s40792-015-0025-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/27/2015] [Indexed: 12/24/2022] Open
Abstract
Purpose Although successful treatment of squamous cell carcinoma (SCC) of the rectum using chemoradiation therapy (CRT) has been reported, a standard protocol has yet to be established. The aim is to ascertain the effectiveness of CRT with S-1 for three patients with SCC of the rectum. Case presentation We treated three female patients complaining of rectal bleeding. The patients were diagnosed as having primary SCC of the rectum by means of routine examinations; one of them was a very rare case because of the presence of two lesions in the lower rectum. We treated the patients using CRT with S1 at a radiation dose of 1.8 Gy/fraction given five times weekly (Monday to Friday) to a median dose of 59.4 (45 to 59.4) Gy; S-1 (80 mg/m2/day) was administered orally during radiation therapy. One of three patients had an adverse event involving massive hemorrhage from the tumor. All patients exhibited an excellent response to CRT with S-1; two patients had a complete response, and one patient had a partial response and underwent a posterior pelvic exenteration with advancement flap reconstruction as a salvage treatment. Pathological examination of the resected specimen and lymph nodes revealed no tumor cells indicating a pathological complete response. In this series, the response rate was 100%. Conclusions We suggest that CRT with S-1 be chosen as the first-line therapy for SCC of the rectum. However, a large study will be required to establish a safe and effective regimen.
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Affiliation(s)
- Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Tetsuo Nemoto
- Department of Pathology, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Junichi Koike
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Akiharu Kurihara
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Hiroyuki Shiokawa
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Mistunori Ushigome
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Tomoaki Kaneko
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Kenichiro Arai
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Yasuo Nagashima
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Takamaru Koda
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Takayuki Suzuki
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Satoru Kagami
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Yu Suitsu
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Hironori Kaneko
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Toshikazu Shibuya
- Department of Pathology, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
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16
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Cho DK, Kim SH, Cho SB, Lee WS, Joo YE. [Primary squamous cell carcinoma of the ascending colon: report of a case and Korean literature review]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 64:98-102. [PMID: 25168052 DOI: 10.4166/kjg.2014.64.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Primary squamous cell carcinoma of the colon is an extremely rare malignancy. A 48-year-old male visited our hospital for screening colonoscopy. Colonoscopic examination showed a 1 cm sized sessile polyp in the ascending colon. The patient underwent endoscopic mucosal resection (EMR) without any complication. The pathologic findings were compatible with squamous differentiation of tumor cells in inflammatory colonic mucosa. The tumor was confined to the mucosa and the margins of the excised tissue were found to be free of the tumor. There were no other primary sites and no distant metastases in the extensive evaluation using a whole body CT scan and PET-CT. Additional surgical resection was not done. Follow-up colonoscopy performed eight month later showed a whitish scar without evidence of local recurrence and follow-up PET-CT demonstrated no evidence of recurrence. Herein, we report a case of primary squamous cell carcinoma of the ascending colon presenting as a sessile polyp which was removed by EMR.
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Affiliation(s)
- Dong Keun Cho
- Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 501-746, Korea
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17
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Choi JW, Park HU. Adenosquamous carcinoma of the ascending colon: a case report and review of the literature. Ann Coloproctol 2013; 29:83-6. [PMID: 23700577 PMCID: PMC3659249 DOI: 10.3393/ac.2013.29.2.83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 03/16/2013] [Indexed: 12/24/2022] Open
Abstract
An adenosquamous carcinoma is a malignancy that has both glandular and squamous histologic components. Both components are malignant and have potential to metastasize. An adenosquamous carcinoma of the large bowel is rare, and its clinicopathologic behavior is not fully understood. It is reported to be more aggressive and have a worse prognosis when it is compared with an adenocarcinoma alone. We present a case of an adenosquamous carcinoma in the ascending colon which was laparoscopically resected and followed by adjuvant chemotherapy.
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Affiliation(s)
- Jae Won Choi
- Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
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18
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Morito K, Kai K, Miyoshi A, Kubo H, Ide T, Azama S, Irie H, Koga Y, Sumi K, Ikeda O, Kitahara K, Noshiro H. Primary squamous cell carcinoma of the liver concomitant with primary colon cancer: report of a case. Clin J Gastroenterol 2013; 6:134-138. [PMID: 26181450 DOI: 10.1007/s12328-012-0341-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/18/2012] [Indexed: 02/05/2023]
Abstract
A 55-year-old Japanese female was admitted to our hospital to treat colon cancer. Computed tomography revealed a 2.6 × 2.0 cm liver mass considered to be liver metastasis. She synchronously underwent right colectomy with D3 lymph node dissection and subsegmentectomy 8 under the diagnosis of advanced colon cancer with liver metastasis. The pathology examination revealed the liver nodule was pure squamous cell carcinoma (SCC), whereas histology of colon cancer was a well differentiated tubular adenocarcinoma containing no squamous component. The patient underwent intensive checkup by imaging for a primary site of SCC. However, no lesion considered as possible primary site of SCC was found. Therefore, the liver nodule was finally diagnosed as a primary hepatic SCC. Primary SCC of the liver is a rare and high-grade malignant tumor. Recurrent multiple liver nodule was found at 13 months after surgery and the patient died of cancer 17 months after surgery.
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Affiliation(s)
- Kiyoto Morito
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan.
| | - Keita Kai
- Department of Pathology and Microbiology, Saga University Faculty of Medicine, Saga, Japan
| | - Atsushi Miyoshi
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan
| | - Hiroshi Kubo
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan
| | - Takao Ide
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan
| | - Shinya Azama
- Department of Radiology, Saga University Faculty of Medicine, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Saga University Faculty of Medicine, Saga, Japan
| | - Yasuo Koga
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan
| | - Kenji Sumi
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan
| | - Osamu Ikeda
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan
| | - Kenji Kitahara
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Nabesima 5-1-1, Saga, Saga, 849-8501, Japan
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19
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Chen YC, Tsai HL, Lin CH, Huang CJ, Wang JY. Adenosquamous carcinoma of the colon. GENOMIC MEDICINE, BIOMARKERS, AND HEALTH SCIENCES 2012; 4:103-106. [DOI: 10.1016/j.gmbhs.2012.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
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20
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Kiselev E, Empey N, Agama K, Pommier Y, Cushman M. Dibenzo[c,h][1,5]naphthyridinediones as topoisomerase I inhibitors: design, synthesis, and biological evaluation. J Org Chem 2012; 77:5167-72. [PMID: 22587603 PMCID: PMC3370419 DOI: 10.1021/jo3006039] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dibenzo[c,h][1,5]naphthyridinediones were prepared via a novel synthetic pathway. The compounds were designed as topoisomerase I (Top1) inhibitors based on the indenoisoquinoline series of drugs. The results of biological evaluation demonstrate that, unlike very closely related dibenzo[c,h][1,6]naphthyridinediones, dibenzo[c,h][1,5]naphthyridinediones retain the Top1 inhibitory activity of similarly substituted indenoisoquinolines.
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Affiliation(s)
| | | | | | | | - Mark Cushman
- To whom correspondence should be addressed. Phone: 765-494-1465. Fax: 765-494-6790.
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21
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Kang DB, Oh JT, Jo HJ, Park WC. Primary adenosquamous carcinoma of the colon. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80 Suppl 1:S31-5. [PMID: 22066079 PMCID: PMC3205367 DOI: 10.4174/jkss.2011.80.suppl1.s31] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 04/23/2010] [Indexed: 12/16/2022]
Abstract
Adenosquamous cell carcinoma (Ad-SCC) of the colon is rare. The pathogenesis of Ad-SCC is unclear, however, several hypotheses have been suggested. The clinical presentation and gross findings of Ad-SCC of the colon are similar to those of adenocarcinoma of the colon, but Ad-SCC has a more aggressive clinical course and a poorer prognosis. We report on two cases of Ad-SCC of the colon with obstruction; a collision-type Ad-SCC that has not only obstruction but also numerous hepatic metastases, and a composite-type Ad-SCC treated with left hemicolectomy followed by an adjuvant chemotherapy.
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Affiliation(s)
- Dong Baek Kang
- Department of Surgery, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
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22
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23
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Sameer AS, Syeed N, Chowdri NA, Parray FQ, Siddiqi MA. Squamous cell carcinoma of rectum presenting in a man: a case report. J Med Case Rep 2010; 4:392. [PMID: 21118539 PMCID: PMC3014960 DOI: 10.1186/1752-1947-4-392] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 11/30/2010] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Primary squamous cell carcinomas of the colorectum are very uncommon. Until now, to the best of our knowledge, only 114 cases of squamous cell carcinoma in the colorectum exist in the reported literature. Here we report a case of squamous cell carcinoma of the rectum in the ethnic Kashmiri population in northern India. CASE PRESENTATION The case of a 60-year-old male patient (Asian) with a pure squamous cell carcinoma of the rectum is presented here. The patient underwent a curative surgery with concomitant chemotherapy. Two years after the initial curative resection of the tumor he is still alive. CONCLUSION The prognosis for squamous cell carcinoma of the colorectum is worse than for that of adenocarcinoma, because of the delayed diagnosis. The etiopathogenicity of squamous cell carcinoma of the colorectum is discussed. Surgical resection of the lesion seems to be the treatment of choice. Chemotherapy also helps in improvement of the prognosis.
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Affiliation(s)
- A Syed Sameer
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 90011, India
- Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 190011, India
- Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 190011, India
| | - Nidda Syeed
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 90011, India
| | - Nissar A Chowdri
- Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 190011, India
| | - Fazl Q Parray
- Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 190011, India
| | - Mushtaq A Siddiqi
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 90011, India
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24
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Iannacone E, Dionisi F, Musio D, Caiazzo R, Raffetto N, Banelli E. Chemoradiation as definitive treatment for primary squamous cell cancer of the rectum. World J Radiol 2010; 2:329-33. [PMID: 21160687 PMCID: PMC2999332 DOI: 10.4329/wjr.v2.i8.329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 06/29/2010] [Accepted: 07/06/2010] [Indexed: 02/06/2023] Open
Abstract
In this report, we present a case of advanced squamous cell cancer located in the rectum of a 78-year-old woman treated with chemoradiation with curative intent. The patient showed a complete clinical response to chemoradiation; multiple biopsies were performed at the site of the previous mass 5 mo after the end of treatment and histological examination showed no residual tumour in the specimens. Surgical intervention was avoided and the patient was free of disease 12 mo after the diagnosis of cancer. Primary chemoradiation should be considered as the treatment of choice for this rare malignancy.
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25
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Al Hallak MN, Hage-Nassar G, Mouchli A. Primary Submucosal Squamous Cell Carcinoma of the Rectum Diagnosed by Endoscopic Ultrasound: Case Report and Literature Review. Case Rep Gastroenterol 2010; 4:243-249. [PMID: 20805951 PMCID: PMC2929423 DOI: 10.1159/000319013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary colorectal squamous cell carcinoma (SCC) is one of the very rare malignancies of the gastrointestinal tract. The diagnosis cannot be made before ruling out other common primary sites. Using the endoscopic ultrasound (EUS) technique to get a tissue biopsy for submucosal tumors has not been demonstrated as the best diagnostic approach in the literature. Surgery is the gold standard treatment with arising evidence of good efficacy following conventional chemoradiation therapy. A 49-year-old male presented with rectal discomfort. Sigmoidoscopy revealed multiple submucosal masses in the rectosigmoid colon. Mucosal biopsies showed nonspecific inflammation. Subsequently, an EUS with fine needle biopsy was done and established the diagnosis of rectal SCC. There were no other primary sites noticed in the extensive evaluation. The patient chose to be treated only with chemoradiation without surgery. At the time of writing this report he had no evidence of recurrence achieving 2.5 years of survival. EUS is an emerging excellent approach to diagnose submucosal colorectal SCC. This case will add supportive evidence of having a complete response following combining treatment with squamous cell directed chemotherapy and external beam radiotherapy without preceded surgery.
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26
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Matsuda A, Takahashi K, Yamaguchi T, Matsumoto H, Miyamoto H, Kawakami M, Kawachi H, Suzuki H, Furukawa K, Tajiri T, Mori T. HPV infection in an HIV-positive patient with primary squamous cell carcinoma of rectum. Int J Clin Oncol 2009; 14:551-554. [PMID: 19967495 DOI: 10.1007/s10147-009-0890-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 02/23/2009] [Indexed: 12/13/2022]
Abstract
Primary squamous cell carcinoma (SCC) of the colorectum is a rare malignancy of unknown etiology and pathogenesis. We report a case of primary SCC of the rectum. A 55-year-old man with a rectal tumor and human immunodeficiency virus (HIV) infection was referred to our hospital. Histopathology of biopsy specimens showed characteristics of SCC. We diagnosed the patient as having primary moderately differentiated SCC of the rectum according to the criteria proposed by Cooper. Human papillomavirus (HPV) DNA was amplified by polymerase chain reaction analysis of unfixed tumor biopsy specimens. In addition, no p53 overexpression or nuclear staining of retinoblastoma protein (Rb) was observed in neoplastic cells by immunohistochemical staining. We suggest from our case that HPV infection following the inactivation of the cellular tumor suppressor Rb and the immune suppression induced by HIV infection play an etiologic role in the pathogenesis of rectal SCC, consistent with the well-established concept of HPV-associated anal carcinogenesis.
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Affiliation(s)
- Akihisa Matsuda
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
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27
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Okabayashi K, Hasegawa H, Ishii Y, Endo T, Kitagawa Y. Adenosquamous carcinoma of the sigmoid colon treated by the less invasive procedures of endoscopy and laparoscopy: report of a case. Surg Today 2009; 39:994-7. [PMID: 19882324 DOI: 10.1007/s00595-009-3961-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 01/29/2009] [Indexed: 11/24/2022]
Abstract
A 51-year-old man demonstrated a positive finding for a fecal occult blood test during a screening examination. Total colonoscopy was therefore performed, and a semi-pedunculated polyp was detected in the sigmoid colon. Although this polyp was suspected of invading the submucosal layer, it was removed endoscopically because the preoperative diagnosis was well-differentiated adenocarcinoma. The pathological findings revealed adenosquamous carcinoma that had invaded the submucosal layer with lymphatic invasion. A laparoscopic bowel resection was then performed and a histopathological examination of the surgical specimen showed metastasis to two regional lymph nodes. The patient is alive and recurrence-free 22 months after the operation. Adenosquamous carcinoma has been reported to be rare and to possess a highly metastatic potential. It consists of both squamous cells and glandular cell components. We report a case of adenosquamous carcinoma of the sigmoid colon treated by less invasive approaches consisting of an endoscopic mucosal resection and a subsequent laparoscopic colectomy.
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Affiliation(s)
- Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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28
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Abstract
Squamous cell carcinoma of the rectum is a rare malignancy. It appears to be associated with chronic inflammatory conditions and infections. The clear association seen between Human Papilloma Virus and various squamous cancers has not been firmly established for the squamous cell cancer of the rectum. The presentation is nonspecific and patients tend to present with advanced stage disease. Diagnosis relies on endoscopic examination with biopsy of the lesion. Distinction from squamous cell cancer of the anus can be difficult, but can be facilitated by immunohistochemical staining for cytokeratins. Staging of the cancer with endoscopic ultrasound and computed tomography provides essential information on prognosis and can guide therapy. At present, surgery remains the main therapeutic option; however recent advances have made chemoradiation a valuable therapeutic addition. Squamous cell carcinoma of the rectum is a distinct entity and it is of crucial importance for the practicing Gastroenterologist to be thoroughly familiar with this disease. Compared to adenocarcinoma of the rectum and squamous cell cancer of the anal canal, squamous cell carcinoma of the rectum has different epidemiology, etiology, pathogenesis, and prognosis but, most importantly, requires a different therapeutic approach. This review will examine and summarize the available information regarding this disease from the perspective of the practicing gastroenterologist.
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29
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Rasheed S, Yap T, Zia A, McDonald PJ, Glynne-Jones R. Chemo-radiotherapy: an alternative to surgery for squamous cell carcinoma of the rectum--report of six patients and literature review. Colorectal Dis 2009; 11:191-7. [PMID: 18462236 DOI: 10.1111/j.1463-1318.2008.01560.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Since 1943 [1], only 45 patients of squamous cancer of the rectum have been reported in the published reports and the largest series to date consists of 12 patients. Reports suggest that the primary treatment is surgical resection but, in the light of nonsurgical advances in the treatment of anal squamous cell carcinoma (SCC), we present a review of the literature and report six patients treated by chemoradiation therapy (CRT). METHOD A literature search was undertaken using the keywords squamous cell, epidermoid, basaloid and cloacagenic and cancer of rectum and colon to provide evidence for this discussion from studies of surgery, radiation therapy and CRT in rectal SCC. A prospective database of the Mount Vernon Cancer Centre, UK was searched from 1995 to 2005 for patients diagnosed with pure SCC of the rectum. RESULTS Six patients with histologically confirmed primary SCC of the rectum were treated with primary combination chemo-radiotherapy according to protocols used for SCC of the anal canal over a 15-year period. Surgery was avoided in four, and they remain disease-free on follow-up. CONCLUSIONS Primary CRT, as currently utilized in anal cancer, can be extended to primary SCC of the rectum.
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Affiliation(s)
- S Rasheed
- Northwick Park and St Mark's Hospitals, Harrow, Middlesex, UK
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30
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Yokoi K, Tanaka N, Furukawa K, Seya T, Ohaki Y, Tajiri T. A Case of Adenosquamous Carcinoma of the Ascending Colon. J NIPPON MED SCH 2008; 75:242-6. [DOI: 10.1272/jnms.75.242] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kimiyoshi Yokoi
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Noritake Tanaka
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Kiyonori Furukawa
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Tomoko Seya
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Yoshiharu Ohaki
- Department of Pathology, Nippon Medical School Chiba Hokusoh Hospital
| | - Takashi Tajiri
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
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Nahas CSR, Shia J, Joseph R, Schrag D, Minsky BD, Weiser MR, Guillem JG, Paty PB, Klimstra DS, Tang LH, Wong WD, Temple LK. Squamous-cell carcinoma of the rectum: a rare but curable tumor. Dis Colon Rectum 2007; 50:1393-400. [PMID: 17661147 DOI: 10.1007/s10350-007-0256-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to evaluate one institution's experience with treatment outcomes for rectal squamous-cell carcinoma. METHODS Using our prospective Colorectal Database, we identified patients diagnosed with rectal squamous-cell carcinoma at our institution between 1983 and 2005. Pathology was rereviewed, tumor immunophenotype was compared to control cases of anal squamous-cell carcinoma and rectal adenocarcinoma, treatment modalities and outcomes were analyzed. RESULTS Twelve patients were identified (10 females median age, 58 years). Median distal extent of tumors was 7 (range, 5-8) cm from the anal verge. Treatment included chemotherapy only (n = 1), chemoradiation only (n = 2), induction chemotherapy followed by chemoradiation and surgery (n = 2), chemoradiation followed by surgery (n = 5), and surgery followed by chemoradiation (n = 2). The chemotherapy regimen was 5-fluorouracil-based. Radiotherapy total dose was 50.4 Gy (1.8 Gy/day, daily x 5) external iliac and inguinal nodes were not included in the radiation field. Complete clinical responders to chemoradiation (n = 2) received no further treatment. All seven partial responders underwent surgery; six had complete pathologic response; nodal status in two of six was unknown because they had local excision. Immunophenotypical analysis showed similar keratin expression profile between rectal squamous-cell carcinoma (n = 5) and rectal adenocarcinoma (n = 5), which is different from anal squamous-cell carcinoma (n = 10). All patients were alive without evidence of disease at follow-up (median follow-up, 2.6 (range, 0.5-16) years). CONCLUSIONS Our data suggest that most patients treated with upfront chemoradiation therapy followed by surgery did well. Sphincter-preserving surgery is usually feasible. Clinical judgment of tumor response after chemoradiation is not completely reliable. Immunohistochemistry suggests a common cellular origin for rectal squamous-cell carcinoma and rectal adenocarcinoma, which is different from anal squamous-cell carcinoma.
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Affiliation(s)
- Caio S R Nahas
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Kang H, O'Connell JB, Leonardi MJ, Maggard MA, McGory ML, Ko CY. Rare tumors of the colon and rectum: a national review. Int J Colorectal Dis 2007; 22:183-9. [PMID: 16845516 DOI: 10.1007/s00384-006-0145-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Most literature available on rare colorectal cancer (CRC) is from case series reports. This population-based evaluation is the first comprehensive look at four rare histologic types of CRC, allowing comparisons with the more common adenocarcinoma for clinical and pathological features and survival rates. MATERIALS AND METHODS All patients diagnosed with carcinoid (n=2,565), malignant lymphoma (n=955), non-carcinoid neuroendocrine (n=455), squamous cell (n=437), and adenocarcinoma (n=164,638) in SEER cancer database (1991-2000) were analyzed. Evaluation of age-adjusted incidence rate, stage at presentation, and 5-year relative survival were determined for each histologic subtype. RESULTS All rare histologic subtypes had younger mean age than adenocarcinomas (70 years; p<0.05). Lymphoma was more common in males (65.1%; P<0.01). Incidence rates in 2000 per million were: carcinoid 10.6, lymphoma 3.5, neuroendocrine 2.0, squamous 1.9, and adenocarcinoma 496.3. The annual percent change in incidence for each rare tumor increased significantly during the 10 years (range: 3.1-9.4%, p<0.05), except squamous cell carcinoma (5.9%, p>0.05). Squamous (93.4%) and carcinoid (73.7%) tumors occurred more often in the rectum; lymphoma (79.0%), neuroendocrine (70.8%), and adenocarcinoma (70.1%) occurred more often in the colon (P<0.01). Carcinoids presented at earlier stage (localized/regional, 90.5%) more often than adenocarcinoma (80.6%; p<0.01), but squamous cell (82.1%; p=0.50), lymphoma(70.6%; p<0.01), and neuroendocrine (37.8%; p<0.01) presented at earlier stage similarly or less often than adenocarcinoma. Relative 5-year survival rate was highest for carcinoid (91.3%), and lowest for neuroendocrine tumors (21.4%). CONCLUSION This study provides the first population-based analysis of the epidemiology, tumor characteristics, and survival rates for rare CRC.
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Affiliation(s)
- Hakjung Kang
- Department of Surgery, Daehang Hospital, Seoul, South Korea
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Theodosopoulos TK, Marinis AD, Dafnios NA, Vassiliou JG, Samanides LD, Carvounis EE, Smyrniotis VE. Aggressive treatment of metastatic squamous cell carcinoma of the rectum to the liver: a case report and a brief review of the literature. World J Surg Oncol 2006; 4:49. [PMID: 16895595 PMCID: PMC1555584 DOI: 10.1186/1477-7819-4-49] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 08/08/2006] [Indexed: 12/13/2022] Open
Abstract
Background Rectal squamous cell carcinoma (SCC) is a rare tumor. The incidence of this malignancy has been reported to be 0.25 to 1 per 1000 colorectal carcinomas. From a review of the English literature 55 cases of SCC of the rectum have been published. In this study we report a rectal metastatic SCC to the liver, discussing the efficacy of aggressive adjuvant and neo-adjuvant therapies on survival and prognosis. Case presentation A 39-year-old female patient with a pure SCC of the rectum diagnosed endoscopically is presented. The patient underwent initially neoadjuvant chemo-radiotherapy and then abdominoperineal resection with concomitant bilateral oophorectomy and hysterectomy, followed by adjuvant chemo-radiotherapy. Five months after the initial operation liver metastasis was demonstrated and a liver resection was carried out, followed by adjuvant chemotherapy. Eighteen months after the initial operation the patient is alive. Conclusion Although prognosis of rectal SCC is worse than that of adenocarcinoma, an aggressive therapeutic approach with surgery as the primary treatment, followed by combined neo- and adjuvant chemo-radiotherapy, may be necessary in order to improve survival and prognosis.
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Affiliation(s)
- Theodosios K Theodosopoulos
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Athanasios D Marinis
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Nikolaos A Dafnios
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - John G Vassiliou
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Lazaros D Samanides
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Eleni E Carvounis
- Department of Pathology, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Vassilios E Smyrniotis
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
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Cuffy M, Abir F, Longo WE. Management of Less Common Tumors of the Colon, Rectum, and Anus. Clin Colorectal Cancer 2006; 5:327-37. [PMID: 16512991 DOI: 10.3816/ccc.2006.n.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The majority of colorectal and anal malignancies are adenocarcinomas and squamous cell cancers, respectively. Despite the predominance of these neoplasms in these locations, rare histiotypes of the colon, rectum, and anus do occur. These histotypes include but are not limited to lymphoma, melanoma, diffuse cavernous hemangioma, and sarcomas, such as leiomyosarcoma or Kaposi's sarcoma. These tumors often present challenges to clinicians with respect to diagnosis, staging, management, and pathology because of their unfamiliarity. A Medline search using "colon," "rectum,""anus," "lymphoma," "melanoma," "diffuse cavernous hemangioma," "squamous cell carcinoma," "carcinoid," "sarcoma," "leiomyosarcoma," "Kaposi's sarcoma," "Paget's disease," "Bowen's disease," and "basal cell carcinoma" as key words was performed as well as a cross-referencing of the bibliography cited in each work. Rare tumors of the colon, rectum, and anus present diagnostic and management dilemmas for clinicians. Because of their infrequency and poor prognosis, the optimal management of these tumors is controversial. For some histotypes, such as squamous cell carcinoma and carcinoids of the rectum, treatment depends on location and size of the tumor. For uncommon anal lesions, such as Bowen's disease, Paget's disease, and basal cell carcinoma, wide local excision (WLE) with negative margins is the standard of care. For other lesions such as anorectal melanoma or leiomyosarcoma, abdominal perineal resection versus WLE is still being debated. Because the optimal treatment of these tumors is still unclear, we recommend a multidisciplinary approach including a surgeon, primary care physician, medical oncologist, radiation oncologist, and pathologist to offer the patient the best outcome.
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Affiliation(s)
- Madison Cuffy
- Yale University School of Medicine, Department of Surgery, New Haven, CT 06520-8062, USA
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Anagnostopoulos G, Sakorafas GH, Kostopoulos P, Grigoriadis K, Pavlakis G, Margantinis G, Vugiouklakis D, Arvanitidis D. Squamous cell carcinoma of the rectum: a case report and review of the literature. Eur J Cancer Care (Engl) 2005; 14:70-4. [PMID: 15698388 DOI: 10.1111/j.1365-2354.2005.00523.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Squamous cell carcinoma of the colon and rectum are extremely rare neoplasms. Many questions regarding their histogenesis and biological behaviour remain unanswered. Surgery is the most effective therapy, and adjuvant chemotherapy and radiotherapy should be considered, especially for node-positive patients. We present a patient with squamous cell carcinoma of the middle rectum who underwent abdominoperineal resection and postoperative adjuvant chemotherapy. The pertinent literature is reviewed.
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Affiliation(s)
- G Anagnostopoulos
- Department of Gastroenterology, 251 Hellenic Air Force Hospital, Athens, Greece
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Gelas T, Peyrat P, Francois Y, Gerard JP, Baulieux J, Gilly FN, Vignal J, Glehen O. Primary squamous-cell carcinoma of the rectum: report of six cases and review of the literature. Dis Colon Rectum 2002; 45:1535-40. [PMID: 12432303 DOI: 10.1007/s10350-004-6462-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The majority of colorectal carcinomas diagnosed are adenocarcinomas. Squamous-cell carcinoma is a rare pathologic curiosity. Since 1943, only 18 cases have been described in the medical literature. The aim of this study was to report retrospectively six new cases and to review the medical literature. PATIENTS Of the 6 cases, 4 were females, and age ranged from 43 to 93 years. Tumors were located 7 to 12 (mean, 8.5) cm from the anal verge. Five patients underwent surgical resection. Intraoperative radiotherapy was performed in one case. One patient was treated only by external beam radiotherapy. In two cases neoadjuvant combination of external beam radiotherapy and chemotherapy and in one case neoadjuvant contact x-ray treatment were performed. This treatment was followed by external beam radiotherapy in two cases and by chemotherapy in two cases, in patients with lymph node involvement. RESULTS The clinical tumor response to radiotherapy was almost complete for the patient who did not undergo surgery. One tumor was sterilized by preoperative radiation. Three patients were alive without recurrence at 6 months, 2 years, and 16 years. CONCLUSION The etiopathogenicity of squamous-cell carcinoma of the rectum is discussed. The prognosis of these tumors seems to be worse than that for adenocarcinoma because of a delayed diagnosis. Surgical resection seems to be the most important treatment. Chemotherapy and especially radiotherapy may have some indications.
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Affiliation(s)
- Thomas Gelas
- Département de Chirurgie Viscérale, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite cedex, France
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Schlegel RD, Dehni N, Cravino AT, Tiret E, Prevot S, Waisman HJ, Parc R. Primary adenosquamous carcinoma of the rectum. Report of 4 cases and review of the literature. Colorectal Dis 2001; 3:201-3. [PMID: 12790990 DOI: 10.1046/j.1463-1318.2001.00225.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review the experience of two referral centres in the management of an infrequent condition: primary adenosquamous carcinoma of the rectum, a rare disease. MATERIALS AND METHODS Four cases of primary adenosquamous carcinomas of the rectum are reported with a review of the literature. No preoperative diagnosis of adenosquamous carcinoma was established. All tumours were located in the rectum. Two patients presented with liver metastasis. No preoperative therapies were indicated. All patients underwent surgery. RESULTS Patients underwent anterior resections (n=2), recto-sigmoid resection (n=1) and abdomino-perineal excision (n=1). All resected specimens had positive lymph nodes and metastatic liver disease was confirmed in the two cases. No adjuvant therapy was carried out after surgery and patients died within 8 months after surgical treatment. CONCLUSIONS Adenosquamous carcinoma of the rectum is a rare and aggressive tumour characterized by coexisting of malignant glandular and squamous components. Presentation is usually at an advanced stage. The tumour is aggressive and metastatic disease at the time of diagnosis is common. Surgery is the treatment of choice. Adjuvant therapy is difficult to evaluate prospectively due to the rarity of the condition. Survival is less than 50% than that for adenocarcinoma.
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Affiliation(s)
- R D Schlegel
- Department of Surgery, Hospital de Clínicas José de San Martín, University of Buenos Aires, Argentina.
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38
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Frizelle FA, Hobday KS, Batts KP, Nelson H. Adenosquamous and squamous carcinoma of the colon and upper rectum: a clinical and histopathologic study. Dis Colon Rectum 2001; 44:341-6. [PMID: 11289278 DOI: 10.1007/bf02234730] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Squamous and adenosquamous carcinoma of the colon and proximal rectum are rare neoplasms in which the clinicopathologic behavior and the most appropriate management are unknown. The purpose of this study was to review the histology and clinical course of the largest series of cases ever reported from a single center on this rare condition. METHOD The Mayo Clinic tissue registry was searched for all primary cases of squamous and adenosquamous carcinoma of the colon or rectum proximal to 8 cm from the dentate and presenting before December 31, 1992. Of the 52 identified cases there was adequate histologic material for review in 44 cases. These cases were divided into pure squamous-cell carcinoma (n = 11), mixed adenosquamous carcinoma (n = 31), and adenocarcinoma with benign-appearing squamous metaplasia (adenoacanthoma; n = 2). Squamous-cell carcinomas were examined for evidence of human papilloma virus by in situ hybridization. A retrospective review of medical records was undertaken in all 52 cases with respect to predisposing factors, clinicopathologic behavior, prognostic features, and treatment with adjuvant therapy. RESULTS The charts of 52 patients (20 females), with a mean age of 58.6 (range, 19-90) years, were reviewed. Right-sided lesions were the most common (43 percent). Metastatic disease was evident at presentation in 49 percent of patients, the most common sites in order being liver, peritoneal, and lung. The five-year overall survival rate was 34 percent, Stage I to III disease had a 65 percent five-year survival rate, and Stage IV mean survival time was 8.5 months. For node-positive and node-negative disease, 23 and 85 percent, respectively, survived five years. There was no evidence of human papilloma virus in the six squamous-cell carcinomas examined. CONCLUSION Squamous and adenosquamous carcinomas of the colon and rectum are rare neoplasms. Although a poor prognosis can be expected for node-positive disease, patients with negative nodes do generally the same as patients with adenocarcinoma histology. Based on advances made with multimodality therapy of squamous-cell cancer of the anus and adenocarcinoma of the rectum, further studies should define the role of postoperative therapies for these lesions.
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Affiliation(s)
- F A Frizelle
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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39
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Sotlar K, Köveker G, Aepinus C, Selinka HC, Kandolf R, Bültmann B. Human papillomavirus type 16-associated primary squamous cell carcinoma of the rectum. Gastroenterology 2001; 120:988-94. [PMID: 11231953 DOI: 10.1053/gast.2001.22523] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary squamous cell carcinoma (SCC) of the colorectum is an extremely rare malignancy of unknown etiology and pathogenesis. We describe an 87-year-old man with primary SCC of the rectum. Routine histology demonstrated a squamous metaplasia-dysplasia sequence of the rectal mucosa with subsequent malignant transformation. Molecular biologic analysis using polymerase chain reaction (PCR) and in situ hybridization revealed the presence of human papillomavirus type 16 (HPV-16) DNA within metaplastic, dysplastic, and SCC lesions and in tumor-free rectal mucosa. Moreover, nested reverse-transcription PCR showed transcriptional activity of the viral E6/E7 oncogenes in tumor tissue and tumor-free rectal mucosa. By contrast, 4 typical adenocarcinomas of the rectum and their adjacent normal mucosa were found to be negative for HPV by nested PCR. In line with the well-established concept of HPV-associated anogenital carcinogenesis, our results strongly suggest an etiologic role of HPV-16 in the pathogenesis of the metaplasia-dysplasia-SCC sequence in the case described.
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Affiliation(s)
- K Sotlar
- Institute of Pathology, University of Tübingen, Germany.
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40
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Cagir B, Nagy MW, Topham A, Rakinic J, Fry RD. Adenosquamous carcinoma of the colon, rectum, and anus: epidemiology, distribution, and survival characteristics. Dis Colon Rectum 1999; 42:258-63. [PMID: 10211505 DOI: 10.1007/bf02237138] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE There have been 49 cases of adenosquamous carcinoma of the colon, rectum, and anus reported in the English literature. We have reviewed 145 cases of adenosquamous carcinoma to better define epidemiologic and survival characteristics of this extremely rare colon carcinoma. METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results program public use CD-ROM file for the years 1973 through 1992 were reviewed. This represents approximately 9.5 percent of the United States population. Adenosquamous carcinomas arising in the colon, rectum, and anus were identified using the International Classification of Diseases-O codes. The Astler-Coller tumor classification was used for staging. Two-tailed Student's t-test, Mantel-Haenszel chi-squared tests, and generalized Wilcoxon's tests were used for comparisons of means, proportions, and actuarial survival rates, respectively. Survival curves were calculated by the Kaplan-Meier method. RESULTS One hundred forty-five cases of adenosquamous carcinoma were identified, representing 0.06 percent of all colorectal malignancies. The mean age of patients was 67 years. Eighty-four percent of patients were Caucasians, 15 percent were Afro-Americans, and 1 percent were other races. Afro-Americans were diagnosed at a significantly younger age (median age, 62 years; P = 0.03). Fifty-three percent of the carcinomas were located in the sigmoid colon, rectum, and anus, 28 percent in the right colon, and the rest in the middle segment. Seventy-four percent of distal cases were staged A through C, compared with 44 percent of proximal cases. Patients with adenosquamous carcinoma of the sigmoid colon, rectum, and anus survived longer than all other patients (P = 0.001). Patients with adenosquamous carcinoma Stages A and B1 had survival rates similar to patients with comparably staged adenocarcinomas. Fifty percent of the patients, including most of the patients with D stage, died in the first year. Patients with Stages B2, C, and D adenosquamous carcinomas had a significantly shorter survival than the comparably staged adenocarcinomas (P < or = 0.02). The overall adjusted five-year survival rate was 30.7 percent. In those patients who survived more than 24 months, the five-year survival was 84 percent. CONCLUSIONS The survival rates for patients with adenosquamous carcinoma Stages A and B1 are similar to patients with comparably staged colorectal adenocarcinomas. However, we found that patients with colorectal and anal adenosquamous carcinomas staged B2 through D have significantly poorer survival than patients with comparably staged adenocarcinomas, supporting the previous reports of a poor prognosis associated with adenosquamous carcinomas.
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Affiliation(s)
- B Cagir
- Department of Surgery, Jefferson Medical College, Philadelphia, Pennsylvania, USA
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41
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Juturi JV, Francis B, Koontz PW, Wilkes JD. Squamous-cell carcinoma of the colon responsive to combination chemotherapy: report of two cases and review of the literature. Dis Colon Rectum 1999; 42:102-9. [PMID: 10211528 DOI: 10.1007/bf02235191] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The majority of colorectal neoplasms diagnosed are adenocarcinomas. Other histologies such as squamous, adenosquamous, carcinoid tumors, or lymphoid tumors are occasionally identified. Given the rarity of squamous-cell tumors, it is very difficult to study their natural course and response to therapy. An attempt is made to describe the frequency, anatomic location, and response to therapy with a review of the literature. METHODS From the Cancer Registry at the University of Missouri-Columbia Ellis Fischel Cancer Center, tumors of the colon identified above the dentate line were selected for chart review. Data were extracted from cases between the years 1940 and 1996. The key terms used to identify cases were epidermoid, squamous cell, and cancer of the rectum or colon. Using this approach, forty patients were identified and each record was reviewed. RESULTS The majority of these cases were anal cancers with proximal extension into the rectum and were excluded. Of 4,561 cases of epithelial colon and rectal cancers identified, only one additional case of squamous-cell cancer could be verified. In this report we describe a patient with a primary squamous-cell carcinoma of the sigmoid colon with metastatic disease to the liver at diagnosis who responded to systemic chemotherapy. We believe this to be the first reported case of this rare tumor type in which the patient's tumor responded to systemic chemotherapy. Two cases with a thorough review of literature are presented. CONCLUSIONS Primary squamous-cell carcinoma of the colon is a rare malignancy of unknown cause and pathogenesis. Metastatic tumors to the colon should be ruled out in all cases before therapy. Early detection and surgery remain the main therapeutic options, but as presented in our case, response to chemotherapy in advanced disease is encouraging.
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Affiliation(s)
- J V Juturi
- Department of Internal Medicine, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine, USA
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42
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Carr CS, Boulos PB. Two cases of solitary metastases from carcinoma of the lung presenting as primary colonic tumours. Br J Surg 1996; 83:647. [PMID: 8689209 DOI: 10.1002/bjs.1800830519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- C S Carr
- Department of Surgery, University College Hospitals, London, UK
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