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Abstract
BackgroundColorectal carcinoma in the pediatric age group is rare and tends to be very aggressive and present late, due to which it has a very poor prognosis. It may present with distant metastasis; however, metastasis to the testes is very rare and signifies an advanced stage of the disease. Surgery is the only effective modality to cure patients with localized colorectal carcinomas. However, statistics show a higher incidence of unresectable disease and a higher metastasis rate in childhood colorectal carcinomas. We present a case of advanced colorectal carcinoma with testicular metastasis in an adolescent.Case presentationA 15-year-old Indian Hindu boy presented to surgical emergency with signs and symptoms of intestinal obstruction. He also had a history of passing blood and mucus per rectum. On examination he had abdominal distension. On digital rectal examination, a circumferential proliferative growth was felt 1 cm above the anal verge. On scrotal examination, a small nodule was felt in his right testis. In view of intestinal obstruction, he was taken into our emergency operation theater and a diverting loop sigmoid colostomy was performed to relieve the obstruction. A punch biopsy from anorectal growth was taken which suggested signet ring cell adenocarcinoma. Contrast-enhanced computed tomography of his chest, abdomen, and pelvis showed advanced colorectal carcinoma with distant metastasis. Ultrasonography of his testes showed a hypoechoic nodule in the right testis from which a needle aspiration biopsy was done which revealed metastatic adenocarcinoma.ConclusionsChildhood colorectal carcinomas have a very poor prognosis due to their aggressive nature and late presentation. In spite of all the advances in diagnosis and treatments, the overall long-term survival is still dismal in these patients. Due to the rarity of this disease, screening is not recommended for individuals under the age of 50. Thus, to improve outcome, early diagnosis and treatment is paramount. For that to happen, awareness needs to be created regarding pediatric colorectal carcinoma and its signs and symptoms.
Highlights
Colorectal carcinoma in the pediatric age group is rare and tends to be very aggressive and present late, due to which it has a very poor prognosis
Colorectal carcinoma (CRC) is the second most common alimentary tract carcinoma after liver tumors in children with an incidence of 1.3–2 cases per million; it is mostly present in the second decade of life [1,2,3,4]
It tends to be very aggressive and present late, due to which it has a very poor prognosis. It may present with distant metastasis; metastasis to the testes is
Summary
CRC in the pediatric age group along with testicular metastasis is rare. It tends to be very aggressive and presents at a very advanced stage in pediatric patients, due to which it has a very poor prognosis. Availability of data and materials The authors agree to make the raw data and materials described in our manuscript freely available. All authors have read and approved the final manuscript. Consent for publication Written informed consent was obtained from the patient’s of kin for publication of this case report and accompanying images. Author details 1Department of Surgery, AIIMS, New Delhi, India. Author details 1Department of Surgery, AIIMS, New Delhi, India. 2Department of Pathology, AIIMS, New Delhi, India. 3Department of Cardiovascular Radiology, AIIMS, New Delhi, India
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