S2230 A Unique Case of Rectal Adenocarcinoma Presenting as Headache

Abstract

Introduction: Colorectal cancers occur when cells lining the colon and rectum become hyperproliferative and grow out of control. Symptoms of colorectal cancer often do not appear until cancer has advanced, therefore it is important to have timely colon cancer screening. Brain metastases from colorectal carcinoma are a rare entity and we present one such case. Case Description/Methods: The patient is a 27-year-old gentleman with a past medical history significant for irritable bowel syndrome who presented to the emergency room, with complaints of unilateral frontal headache and bloody bowel movements. The patient started experiencing right-sided frontal headache 2 weeks before the presentation which was associated with blurry vision and nausea. The patient also endorsed having multiple episodes of bloody bowel movements associated with rectal pain and tenesmus. The patient also endorsed losing 50 pounds in the last 2 months, which was unintentional, and associated with appetite loss and generalized weakness. On physical examination, the patient was alert, oriented times 3, and had no focal neurological deficits. A CT scan of the head was done which revealed 3x2x3 cms sized oval-shaped isointense mass with cerebral edema and 1 cm midline shift. A CT scan of the abdomen and pelvis was also done which showed the presence of a heterogeneous appearing soft tissue density lesion in the right anterolateral wall of the rectum measuring 2.7x3.9x7.1 cms. The neurosurgery team was consulted and the patient was started on steroids and seizure prophylaxis medication. The patient underwent a craniotomy for intracranial neoplasm excision. The excised mass was sent for pathology which resulted as metastatic adenocarcinoma of colorectal origin. The patient tolerated the procedure well and was referred to oncology and gastroenterology for further management. The patient is scheduled to get a colonoscopy and is about to be initiated on chemotherapy as well (Figure). Discussion: Colorectal cancer is one of the leading causes of death due to cancer in the United States. In general colorectal cancer, metastasize to the liver and lungs, and metastases to the brain are rare. Aggressive surgical resection in selected patients shows improved survival rates and better prognosis. As clinicians, we must be aware of unique presentations of colorectal carcinoma and the importance of colorectal cancer screening. Raising awareness about colorectal carcinoma amongst the general population is of utmost importance.Figure 1.: Ct scan images and Histopathology slides.