Abstract
Synchrony of colorectal adenocarcinoma with neuroendocrine tumor (NET) and hyperparathyroidism with colon adenocarcinoma is a rare entity, reported in a handful of cases. We authors would like to report a rare case of coexistence of poorly differentiated colon adenocarcinoma, NET of appendix and hyperparathyroidism. A 43-year-old Caucasian female was diagnosed with metastatic colon adenocarcinoma involving the caecum and appendiceal orifice. The resected specimen also confirmed presence of concurrent well-differentiated NET in distal half of appendix. For this patient, serum chemistry was significant for severe hypercalcemia with elevated parathyroid hormone and fairly normal range parathyroid hormone-related peptide. Importantly, association among the aforementioned conditions remains elusive and warrants further research; nevertheless, surveillance procedures could be performed in patients, if a correlation exists at all.
Highlights
Colorectal carcinoma is the third most common malignancy in the United States
We unveil a circumstantial instance of simultaneous colon adenocarcinoma, hyperparathyroidism and intestinal Neuroendocrine tumor (NET) in a 43-year-old female
Around 1% of colorectal cancer cases are NET that form within neuroendocrine cells which are involved in hormonal regulation
Summary
Colorectal carcinoma is the third most common malignancy in the United States. Adenocarcinoma is the most well-known subtype of the tumor, diagnosed by biopsies (>90%) with proximal colon being the most involved site [1,2,3]. Right hemicolectomy with ileostomy was performed and resected specimen showed 4.7 cm high-grade (poorly differentiated) adenocarcinoma involving cecum and appendiceal orifice and perforating parietal peritoneum (Figure 2) Pathological staging of this tumor was pT4a, N1b, M1a (AJCC 7th edition) with low probability of microsatellite instability (MSI) found on immunohistochemistry. Surgical pathology report from resected specimen showed a distinct 1 cm welldifferentiated NET in distal half of the appendix invading visceral peritoneum (Figure 3) and staining positively for pancytokeratin and synaptophysin (Figure 3) with low Ki-67 proliferation Index (1%). Pathological staging of this tumor was pT4, N0 (AJCC 7th edition). The patient could not survive for further workup and later died from complications of the disease
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