Abstract
Primary colonic tumours with synchronous ileal carcinoid tumours are rare in occurrence and are mainly found incidentally on autopsies or pathological examination of resected surgical specimens. This article describes a case of adenomatous colonic polyps, adenocarcinoma of sigmoid colon and concurrent malignant carcinoid tumour of ileocaecal junction, detected on colonoscopic examination. The radiological staging investigations revealed no distant spread of disease. The patient was effectively treated with subtotal colectomy, resection of terminal ileum, excision of locoregional lymph nodes and the bowel continuity was restored with stapled ileo-rectal anastomosis. This article is as an example of concomitant presence of two types of malignant tumours, effectively managed surgically.
Highlights
This article describes a case of adenomatous colonic polyps, adenocarcinoma of sigmoid colon and concurrent malignant carcinoid tumour of ileocaecal junction, detected on colonoscopic examination
The patient was effectively treated with subtotal colectomy, resection of terminal ileum, excision of locoregional lymph nodes and the bowel continuity was restored with stapled ileo-rectal anastomosis
The synchronous and metachronous midgut carcinoid tumours are usually detected on staging evaluation, surgical exploration, histological examination and autopsies performed for the primary colonic tumours [3,4] The optimum imaging modality depends on whether it is used for detection of primary tumour or for the assessment of the metastasis
Summary
The bowel continuity was restored with the stapled ileorectal anastomosis. The patient made an uneventful recovery from surgery and was discharged on the 5 post operative days. The final histology confirmed the initial diagnosis of an ileal carcinoid tumour (Figure 3c) and a sigmoid adenocarcinoma (Figure 3a, 3b). The colonic tumour was staged as pT3 pN2 M0R0. The carcinoid tumour was staged as well differentiated neuroendocrine carcinoma (WHO classification) or pT3 pN2 M0R0 (American Joint Committee on Cancer). Adjuvant chemotherapy for the adenocarcinoma was advised following discussion at the Multidisciplinary Team Meeting
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