Rapid progression of colonic mucinous adenocarcinoma with immunosuppressive condition: A case report and review of literature

Table 1 Laboratory examination before steroid pulse therapy

Hematology			Biochemistry			Marker
	Values	Normal range		Values	Normal range		Values	Normal range
WBC	6600	3300-8600/µL	TP	7.4	6.6-8.1 g/dL	HBs Ag	-
Neutro.	64.3	38.0%-71.0%	Alb	4.2	4.1-5.1 g/dL	Anti-HBs	-
Lymph.	29.7	21.0%-50.0%	BUN	9	8-20 mg/dL	Anti-HBc	-
Eos.	0.8	7.3%	Cre	0.62	0.46-0.79 mg/dL	Anti-HCV	-
Bas.	0.2	2.0%	AST	18	13-30 IU/L
Mon.	5.0	3.0%-8.0%	ALT	18	7-23 IU/L	CEA	1.1	< 5.8 ng/mL
RBC	493	386-492 ×104/μL	ALP	179	106-322 IU/L	CA19-9	14	< 37 IU/mL
Hb	14.0	11.6-14.8 g/dL	LDH	145	124-222 IU/L	CA125	8	< 35 IU/mL
Ht.	41.5	35.1%-44.4%	γ-GTP	20	9-32 IU/L
Plt.	26.7	15.8-34.8 ×104/μL	ChE	314	201-421 IU/L
			Na	138	138-145 mEq/L
Coagulation			K	3.2	3.6-4.8 mEq/L
	Values	Normal range	Cl	104	101-108 mEq/L
PT	111	70%-130%	P	2.5	2.7-4.6 mg/dL
PT-INR	0.94	1.0	Ca	9.2	8.8-10.1 mg/dL
APTT	27.4	26.9-40.9 sec	CRP	0.01	< 0.14 mg/dL
			TG	60	30-117 mg/dL
			HDL-C	63	48-103 mg/dL
			LDL-C	88	65-163 mg/dL

WBC: White blood cell; Neutro.: Neutrophil; Lymph.: Lymphocyte; Eos.: Eosinophil; Bas.: Basophil; Mon.: Monocyte; RBC: Red blood cell; Hb: Hemoglobin; Ht.: Hematocrit; Plt.: Platelets; PT%: Prothrombin time; PT-INR: Prothrombin time-international normalized ratio; APTT: Activated partial thromboplastin time; TP: Total protein; Alb: albumin; BUN: blood urea nitrogen; Cre: Creatinine; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; LDH: Lactate dehydrogenase; γ-GTP: γ-glutamyl transpeptidase; ChE: Cholinesterase; Na: sodium; K: Potassium; Cl: Chloride; P: Phosphate; Ca: Calcium; CRP: C-reactive protein; TG: Triglyceride; HDL-C: High density lipoprotein cholesterol; LDL-C: Low density lipoprotein cholesterol; HBs Ag: Hepatitis B surface antigen; Anti-HBs: Hepatitis B surface antibody; Anti-HBc: Hepatitis B core antibody; Anti-HCV: Hepatitis C antibody; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; CA125: carbohydrate antigen 125.

Table 2 Laboratory on admission

Hematology			Biochemistry			Marker
	Values	Normal range		Values	Normal range		Values	Normal range
WBC	12850	3300-8600/µL	TP	6.3	6.6-8.1 g/dL	CEA	97.0	< 5.8 ng/mL
Neutro.	93.7	38.0%-71.0%	Alb	3.6	4.1-5.1 g/dL	CA19-9	255	< 37 IU/mL
Lymph.	4.7	21.0%-50.0%	BUN	10	8-20 mg/dL	AFP	1	< 9.5 ng/mL
Eos.	0.0	7.3%	Cre	0.76	0.46-0.79 mg/dL	AFP-L3	< 0.5	< 10 %
Bas.	0.1	2.0%	T-Bil	0.8	0.4-1.5 mg/dL	PIVKA-II	22.0	< 37.8 ng/mL
Mon.	1.5	3.0%-8.0%	AST	107	13-30 IU/L	IL-2R	1031	122-496 U/mL
RBC	395	386-492 ×104/μL	ALT	165	7-23 IU/L
Hb	11.0	11.6-14.8 g/dL	ALP	1156	106-322 IU/L
Ht.	35.2	35.1%-44.4%	LDH	1309	124-222 IU/L
Plt.	36.6	15.8-34.8 ×104/μL	γ-GTP	489	9-32 IU/L
			Na	136	138-145 mEq/L
			K	4.0	3.6-4.8 mEq/L
			Cl	99	101-108 mEq/L
			Ca	9.1	8.8-10.1 mg/dL
			CRP	1.96	< 0.14 mg/dL

WBC: White blood cell; Neutro.: Neutrophil; Lymph.: Lymphocyte; Eos.: Eosinophil; Bas.: Basophil; Mon.: Monocyte; RBC: Red blood cell; Hb: Hemoglobin; Ht.: Hematocrit; Plt.: Platelets; PT%: Prothrombin time; PT-INR: Prothrombin time-international normalized ratio; APTT: Activated partial thromboplastin time; TP: Total protein; Alb: albumin; BUN: blood urea nitrogen; Cre: Creatinine; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; LDH: Lactate dehydrogenase; γ-GTP: γ-glutamyl transpeptidase; ChE: Cholinesterase; Na: sodium; K: Potassium; Cl: Chloride; P: Phosphate; Ca: Calcium; CRP: C-reactive protein.

Table 3 Summary of colorectal cancer after organ transplantation

No.	Ref.	Immunosuppressant	No. of cases	CRC (occurrence rate, %)	Yr to diagnosis (median, range)	Lesion				SIR	95%CI
						Proximal colon (%)	Distal colon (%)	Rectum (%)	UD (%)
1	Safaeian et al[20]	AZA, CsA, MMF, TAC	224098	790 (0.3)	N/A	408 (51.6)	195 (24.7)	146 (18.5)	41 (5.2)	1.12	1.04-1.20
2	Huo et al[21]	N/A	2105122	53 (0.003)	N/A	N/A	N/A	N/A	N/A	1.82	1.59-2.09
3	Engels et al[22]	N/A	175732	627 (0.4)	N/A	N/A	N/A	N/A	N/A	1.24	1.15-1.34
4	Buell et al[23]	AZA, CsA, MMF, TAC	13000	141 (1.1)	N/A	N/A	N/A	N/A	N/A	1.94	1.64-2.29
5	Aberg et al[24]	CsA, TAC, antibody	540	2 (0.4)	N/A	N/A	N/A	N/A	N/A	1.59	0.19-5.74
6	Merchea et al[26]	AZA, CsA, MMF, TAC, steroid	3946	20 (0.5)	8.7 (0.4-19)	14 (70)	4 (20)	2 (10)	0 (0)	N/A	N/A
7	Rompianesi et al[27]	N/A	8178	34 (0.4)	5.6 (3.8-8.8)	17 (50)	9 (26.5)	8 (23.5)	0 (0)	0.92	0.69-1.20
8	Aigner et al[28]	AZA, CsA, MMF, TAC, steroid	3595	9 (0.3)	5.3 (1.5-10)	4	1	4	0 (0)	N/A	N/A
9	Rademacher et al[29]	AZA, CsA, MMF, TAC, steroid	1616	22 (1.3)	8.2 (0.3-19.9)	N/A	N/A	N/A	N/A	1.9	1.2-2.9
10	Haagsma et al[30]	N/A	174	3 (1.7)	7.9 (5.9-16.7)	N/A	N/A	N/A	N/A	N/A	N/A
11	Park et al[31]	CsA, TAC, Sirolimus, AZA, MMF	360	4 (1.1)	N/A	N/A	N/A	N/A	N/A	N/A	N/A

AZA: Azathioprine; CsA: Cyclosporine; MMF: Mycophenolate mofetil; TAC: Tacrolimus; CRC: Colorectal cancer; UD: Undetermined; SIR: Standardized incidence ratio; N/A, data not available.