History Of Rectal Bleeding Research Articles

Semen and sex-steroid parameters among inflammatory bowel disease ulcerative colitis type according to rectal bleeding grade

Hypogonadism and inflammato-ry bowel disease (IBD) are often associated. This association may influence sexual and reproductive function in IBD, including sperm profile and sex steroid hormones. This study included 59 IBD patients diagnosed with ulcerative colitis type IBD. Anamnesis was carried out regarding the history of the disease, along with a history of rectal bleeding. Evaluation proceeded with sperm and hormone examination if the patient agreed. Progressive motility sperm, immotile sperm, and normal sperm were found to be significantly different between the rectal bleeding groups. In grade 3 (more significant bleeding) progressive sperm (24.81 ± 5.85, p < 0.0001) and normal sperm (6.33 ± 12.56, p = 0.0003) rates tended to be lower, while immotile sperm tended to be higher (44.48 ± 11.21, p < 0.0001). Testosterone and free testosterone levels were also reported to be significantly different between groups, where grade 3 had lower levels 255.9 ± 30.08, p = 0.014 and 4.645 ± 0.5, p = 0.002 respectively. Our study shows that the degree of rectal bleeding influences sperm motility and morphology, as well as testosterone and free testosterone levels. These results can concern managing IBD patients to fulfill reproductive health care.

S2681 A Pain in the Rectum: Syphilis Manifesting as Proctitis

Introduction: Anorectal syphilis is often challenging to diagnose due to the atypical clinical presentation and asymptomatic disease course. Patients who engage in high-risk sexual behavior are at increased risk for sexually transmitted infections. We present a unique case of rectal bleeding and diarrhea secondary to anorectal syphilis. Case Description/Methods: A 31-year-old uninsured man presented to the ER with a 1 month history of rectal bleeding, abdominal pain and diarrhea. His past medical history is remarkable for untreated HIV and Factor V Leiden deficiency. He reported being sexually active with multiple male partners and engaging in unprotected anal receptive intercourse. He denied alcohol, tobacco or ilicit drug use. Vital signs were unremarkable on admission. Physical exam was significant for a soft abdomen with palpable tenderness in the lower quadrants without guarding or rebound tenderness. Digital rectal exam was negative for blood, stool, visible lesions or ulcerations. Labratory analysis revealed a hemoglobin of 15.2 g/dL and HIV CD4 count was 877 per mcL. Chemistry panel including liver tests were within normal limits. Computed tomography (CT) of the abdomen revealed mucosal thickening of the rectum with mild fat stranding consistent with inflammation. In the setting of reported hematochezia and abnormal imaging findings the patient underwent colonoscopy which revealed multiple, shallow ulcerations confined to the rectum. Ulcer biopsies were obtained and revealed active proctitis with spirochetes on immunostaining. Treated was initiated with Penicillin G. He had improvement in abdominal pain and resolution of hematochezia. (Figure) Discussion: Syphilitic proctitis is most often associated with pain on defecation, intermittent rectal bleeding and diarrhea. In high risk patient groups, such as MSM and sex workers, clinical suspicion should be high for sexually transmitted infections that affect the anorectal region. Diagnosis of syphilis is based on clinical findings, serological testing and in some cases, tissue biopsy. Primary disease usually occurs at the exterior anal verge, at points of sexual contact. Our case describes syphylitic ulcerations scattered within the rectum without exterior involvement, making it a highly unusual presentation. Although various diagnostic information can be helpful, it is vitally important that physicians rely on their own expertise and knowledge to recognize subtle findings that may help establish a diagnosis, especially in those who are immunocompromised.Figure 1.: Multiple scattered ulcerations in the rectum (white arrows).

Snapshots Quiz.

A middle-aged man presents with a long history of rectal bleeding and intermittent constipation. What is shown in this intra-operative image?

Inflammatory cap polyp of the sigmoid colon: a case report

BackgroundInflammatory cap polyp is a very rare benign entity of the distal left colon, characterized by inflammatory polyp with a “cap” of fibrinopurulent exudates. They are usually multiple and commonly present with bleeding per rectum or mucoid discharge. Solitary polyp presenting with intermittent intussusceptions is rare.Case presentationWe report the case of a 45-year-old Nepalese male with a solitary inflammatory sigmoid colon polyp. The patient presented with a 1-month history of rectal bleeding, mucoid discharge, and severe colicky abdominal pain due to intussusceptions. On colonoscopy, there was an exophytic mass with surface exudates. Colonic resection and anastomosis were performed, due to recurring partial intestinal obstruction. At a 6-month follow-up, the patient was asymptomatic.ConclusionInflammatory cap polyp is a benign entity, and it should be kept in mind as an important differential diagnosis of exophytic colonic mass with surface exudates.

Hermansky-Pudlak Syndrome: A Rare Cause of Post-polypectomy Bleeding

A colonoscopy is an effective tool for colorectal cancer screening, which aims at identifying precancerous polyps and removing them. Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. Here, we report a rare and interesting case of a 68-year-old man known to have Hermansky-Pudlak syndrome (HPS) who presented with two days history of rectal bleeding one day after he had a screening colonoscopy with polypectomy. He had a drop in his hemoglobin count and was admitted to the medicine floor and given 1-desamino-8-D-arginine vasopressin (DDAVP). Later, his bleeding stopped and he reported improvement in his symptoms. This case illustrates the importance of considering platelet transfusion and/or administration during minor surgical procedures for patients with bleeding diathesis such as Hermansky-Pudlak syndrome.

COVID-19: An Opportunity to Reimagine Colorectal Cancer Diagnostic Testing—A New Paradigm Shift

ABSTRACT Colorectal cancer is the third leading cause of cancer related deaths and to date, the COVID-19 pandemic has led to major disruptions of the diagnosis and treatment pathways of this cancer, which may adversely affect survival outcomes for many years. Colorectal cancer pathways must be maintained at a near normal throughput with urgent attention to the backlog of patients to avoid a potential crisis of avoidable cancer deaths. A radical review and revamping of endoscopy services to improve efficiency during COVID-19 is urgently required. To date most endoscopy units have severely restricted their activity, except for time-critical diagnostic and therapeutic procedures. In the post- COVID-19 recovery phase, access to endoscopy services will increase but capacity will be reduced compared to before the pandemic, due to infection control measures. A pragmatic and safe strategy is urgently needed to clear the backlog of endoscopic procedures and for managing the new symptomatic referrals. We propose the use of non-invasive tests, such as FIT and mSEPT9 combined with “safety netting” to “rule out” colorectal cancer and to reduce the utilization of colonoscopy by up to 80% and limit the procedure to those patients at high risk of cancer.

Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study

BackgroundRectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC.MethodsResults of all FITs requested in primary care for symptomatic patients in the Örebro region during 2015 were retrieved. Data on each patient’s history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden.ResultsA total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1–13.4) and negative predictive value 99.7% (95% CI 99.2–100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6–10.9) and 100% (95% CI 99.6–100).ConclusionThe diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation.

High incidence of advanced stage cancer and prolonged rectal bleeding history before diagnosis in young-onset patients with colorectal cancer.

3576 Background: In contrast to the older population, the incidence of colorectal cancer (CRC) in younger patients (aged &lt; 50 years) has been increasing in the last three decades. Younger patients tend to present with more advanced disease, thought to be in part related to lack of routine screening colonoscopies. The goal of this study was to examine characteristics of young-onset CRC and potentially identify factors that may aid in earlier diagnosis and treatment. Methods: We collected data for patients available through the University of Colorado Cancer Center Cancer Registry. Inclusion criteria included: 1) Diagnosis of colon or rectal cancer between the years 2012-2018 and 2) age at diagnosis of less than 50 years. Pertinent data including baseline characteristics, clinical presentation, family history, pathology, molecular testing, staging, and treatment were collected. Results: 211 patients with young-onset CRC were available for review. Mean age at diagnosis was 42.4 years and 55.5% were males. A total of 42.1% had rectal cancer and a majority of the colon cancer diagnoses had left-sided tumors (66%). Regarding clinical presentation, 52.2% presented with rectal bleeding prior to diagnosis. Of those who presented with rectal bleeding, the average time from the onset of bleeding to diagnosis was 271.17 days. 42.9% of young-onset CRC were stage IV at the time of initial diagnosis. Evaluation of the pathology specimens showed that 89.6% were adenocarcinomas and 63.5% were grade 2 or higher. At diagnosis, the mean BMI was 26.6 and the mean CEA was 135.5. A total of 72.5% of young-onset patients had a positive family history of any cancer. KRAS or NRAS mutations were present in 49.6% of patients, BRAF V600E mutations were present in 3.8%, and 10.8% were MSI-H. Conclusions: Prolonged rectal bleeding history prior to diagnosis was noted in a significant proportion of young-onset patients with colorectal cancer. Patients and primary care physicians should be made aware of this finding in order to facilitate timely referral for colonoscopy which may lead to earlier diagnosis, less advanced disease at diagnosis, and improved outcomes.

Obscure gastrointestinal bleeding resulting from small bowel neoplasia; A case series

IntroductionUndiagnosed gastrointestinal bleeding may originate in the small bowel. This presents a diagnostic challenge despite the advancement in contemporary imaging. We report two cases which highlight the limitations of routine investigation for obscure gastrointestinal bleeding. Presentation of casePatient A presented with a history of rectal bleeding, treated with interventional embolisation of caecal angiodysplasia. A diagnosis of neuroendocrine tumour (NET) was reached two years after presentation following intraoperative right hemicolectomy resection of a presumed recurrent angiodysplastic bleed. Patient B presented with recurrent melaena labelled as non-steroidal anti-inflammatory drug (NSAID) induced gastritis. After multiple endoscopic and radiological investigations, a 4.5 cm mass was visualised on imaging after three years, which was histologically proven as gastrointestinal stromal tumour (GIST) of the small bowel. Both patients experienced a delayed diagnosis despite multiple investigations and careful follow-up. DiscussionOur case series discusses the benefits and limitations of investigation for gastrointestinal bleeding and suggests a need for continued multidisciplinary input in situations where the patient presumed diagnosis remains in question. ConclusionOGIB remains a diagnostic challenge and is attributable to small bowel pathology in 75% of cases. This suggests a need for continued investigation in situations where the patient presents multiple times despite adequate treatment for the presumed underlying condition.

One misfortune is better than thousands of pieces of advice: the warning role of rectal bleeding

Objective: Rectal bleeding is one of the most important symptoms of colorectal cancer that fast-tracks the patient’s consultation with a physician. This study aims to assess the warning role of rectal bleeding in a risk group for colorectal cancer. Besides, the relationship among awareness, various socio-demographic criteria and the reasons for visiting or not visiting the physician was evaluated among greater than or equal to 40 years old. Methods: This descriptive study was conducted thousand one hundred and sixteen (1116) individuals greater than or equal to 40 years old. Awareness of rectal bleeding as a warning sign in participating individuals was assessed by a questionnaire in addition to their family history of cancer or polyps and reasons for visiting or not visiting a physician. Results: A prior history of rectal bleeding was found in 51.9% of subjects. Among those with rectal bleeding history, the rate of visiting a physician due to this bleeding was 49.7%. No statistically significant relationship was found between the frequency of those who contacted their physician and gender, education or age. The frequency of visiting a physician was significantly higher among individuals with a family history of colorectal cancer as compared with no family history and was directly proportional to the degree of family relationship (p = 0.007). Conclusion: Even rectal bleeding does not raise enough attention for visiting a physician. Therefore, public education and screening still have paramount importance in the prevention of colorectal cancer.

A Rare Cause of Colonic Obstruction: Metastatic Breast Cancer to the Rectum

Introduction Breast cancer (BC) is the most prevalent cancer in women and among the leading cause of death in these patients. While BC is known to spread to the bones, lungs, liver, brain, and soft tissues, gastrointestinal (GI) metastasis is rare. Furthermore, metastatic spread specifically to the rectum is exceedingly rare. We present a rare case of a woman with history of breast cancer presenting with rectal metastasis four years after mastectomy. Case Report A 53-year-old woman presented for a colonoscopy following a surveillance abdominal CT scan that showed an incidental thickening of her rectum. There was no history of rectal bleeding. Her past history was significant for grade 2 invasive ductal carcinoma (IDC) of the left breast diagnosed 4 years ago. Immunohistochemical staining was positive for estrogen receptor (ER), progesterone receptor (PR) and negative for human epidermal growth factor receptor 2 (HER2-neu). She was treated with left partial mastectomy, radiation, chemotherapy with Taxotere and cyclophosphamide, and hormonal therapy. She was in remission for approximately 3 years and then found to have recurrence to the bladder when she developed hematuria. At the time of presentation to the colonoscopy, her cancer antigen (CA) 15.3 was 721, CA 125 was 110, and CEA was 23.3. Colonoscopy revealed narrowing at the rectosigmoid with thickened mucosa without a clear obstructive lesion. Even a smaller diameter (11.6 mm) colonoscope could not be passed through the narrow rectosigmoid colon (Image 1). Multiple biopsies showed metastatic carcinoma of primary breast origin (Images 2-3). For her metastatic breast cancer, she was started on various chemotherapy agents including Faslodex and palbociclib and then AZD5363 and olaparib with variable response. Currently she is on Xeloda and has been tolerating it well and does not have any significant obstructive rectal symptoms. Discussion GI metastasis from invasive breast cancer is very rare ( 0.2% for ductal carcinoma and even rarer for lobular carcinoma). Rectal metastasis is even less frequent and only noted in several case reports. This can present masquerading as primary rectal mass, stricture or bleeding, years following the initial diagnosis of breast cancer. As such, physicians should have a heightened suspicion in caring for patients with new anorectal symptoms.1643_A Figure 1 No Caption available.1643_B Figure 2 No Caption available.1643_C Figure 3 No Caption available.

Rectal prolapse in a young adult male patient and its unique aetiology

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A 15 year old girl presented with rectal bleeding, growth failure, digital clubbing and mental retardation

This article has no abstract. The first 100 words appear below:A 15 year old girl of non-com-sanguineous parents presented at the out-patient department with the history of intermittent rectal bleeding for the last 6 years. Rectal bleeding was painless and there was the passage of a small amount of bright red blood drop by drop after defecation. She also complained of something coming out through the anus during defecation for last one year. Mother also noticed that her child had learning difficulties and not growing well like other peers. Her menarche had not started yet. Her elder two sisters and younger two brothers are healthy. She had no family history of rectal bleeding or colorectal cancer.

Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure

Background: Intussusception is a major cause of acute abdomen in childhood. Prompt diagnosis and appropriate treatment of intussusception is of prime importance for preventing morbidity and mortality. In this study, we aimed to investigate the effectivity of ultrasound (USG)-guided hydrostatic reduction of intussusception with saline and to investigate the factors affecting the success of this method. Methods: A total of 100 children with intussusception who were treated by hydrostatic reduction with saline were retrospectively reviewed. The effect of age, gender, duration of symptoms, rectal bleeding, number of reduction attempts performed, and the diameter and length of the invaginated segment measured on USG were evaluated. Results: Successful reduction was achieved in 88 (88%) patients. Mean age was 24.83 months, with 25.59 months in patients with successful reduction and 20 months in patients with failed reduction. Reduction was successful in 83.9% of the patients with a history of rectal bleeding and in 94.7% of the patients with no history of rectal bleeding (P > 0.05). Mean duration of symptoms was 2.74 days in the patients with successful reduction and 4.33 days in the patients with failed reduction. The mean diameter and length of the invaginated segments measured on USG were 3.5 cm and 5.12 cm in the patients with successful reduction and 4.27 cm and 9.23 cm in the patients with failed reduction, respectively. No significant difference was observed between the patients with successful and failed reduction in terms of rectal bleeding, vomiting, gender, age, and body weight (P > 0.05). It was also found that success rate increased as the number of reduction attempts increased and the success rate decreased as the duration of symptoms and the diameter and the length of the invaginated segment increased (P < 0.05). Conclusions: In conclusion, USG-guided reduction of intussusception with saline is a practical and safe method that yields high success rates. Repeating this method in patients with partial reduction that are clinically stable leads to a significant increase in the success of the procedure. A prolonged duration of symptoms and an increase in the size and the diameter of the invaginated segment may have adverse effects on the success of the procedure.

Bleeding meckel’s diverticulum: A study of the accuracy of pertechnetate scintigraphy as a diagnostic tool

BackgroundThe reported accuracy of pertechnetate scintigraphy (Meckel scan) in investigating children with a bleeding Meckel’s diverticulum has increased steadily since it was first introduced into clinical practice in 1970. Recent studies have indicated that the examination has a sensitivity of up to 94% and a specificity of up to 97% in this scenario. There have also been several misleading reviews from Departments of Surgery, suggesting that the Meckel scan has a poor predictive value, and should not be relied upon to exclude a bleeding Meckel’s Diverticulum (MD). ObjectiveThe aim of this study was to assess the accuracy of pertechnetate scintigraphy performed at Our Lady’s Hospital for Sick Children, Crumlin (OLCHC) on children with clinical suspicion of a bleeding MD. MethodThis was a retrospective study of all the Meckel scans performed over a 10year period (2005–2015) in OLCHC, 144 in total. ResultsOf the total 144 scans performed, 22 were considered to be positive, and all patients were found to have a MD at surgery. 122 were negative, and in 53 of these patients, an alternative cause for symptoms was found, often at endoscopy. In the remaining 69 patients, no cause was found, despite full medical work-up. In all of these cases, symptoms resolved, and have not yet recurred, making MD very unlikely. DiscussionPertechnetate scintigraphy, when performed using meticulous technique, can provide up to 100% sensitivity CI [85.1, 100.0] and 100% specificity CI [93.2, 100.0] in diagnosing a bleeding MD in a paediatric population. This examination is seldom of value in children with no history of rectal bleeding.

Primary Squamous Cell Carcinoma of the Rectum Case Report with Literature Review

BACKGROUND: Squamous cell carcinoma of the rectum is a distinct entity. We report a rare case of squamous cell carcinoma of the middle and low rectum. CASE PRESENTATION: The patient was a 60-year-old man who presented with a history of rectal Bleeding, constipation and pelvic painless. Rectoscopy and Colonoscopy revealed a polypoid tumour of the middle and low rectum. Biopsies of this mass revealed a poorly differentiated squamous cell carcinoma of the rectum. Pelvic Magnetic Resonance Imaging scan showed a polypoid, irregular and circumferential tumor in the middle and low rectum extending in length on 95mm. CT scan of the chest, abdomen and pelvis was negative for distal metastases. The patient received combined chemo-radiation. Overall treatment time was 45 days. After 6 weeks of the end of treatment, the revaluation clinical tests by pelvic magnetic resonnance imaging showed a poor response. After 3 months, Positron Emission Tomography with Fluorodeoxyglucose demonstrated a little hypermetabolic area with maximum standard up take value of 6,7 in the low rectum. Patient underwent a surgical resection. The postoperative histopathological findings were non specific and chronic inflammatory changes. At the time this report was written, the patient had 18 months of follow-up. No evidence of malignacy is found. CONCLUSION: Squamous cell carcinoma of the rectum is a distinct entity. Chemoradiation should be chosen as the first-line therapy for suqamous cell carcinoma of the rectum. However,a large study will be required to establish a safe and effective regimen.

CC2 Does mycoplasma genitalium cause proctitis? A case report

Background/introduction Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and cervicitis and pelvic inflammatory disease in women. The overall prevalence of rectal mycoplasma genitalium was 4.4% in one study of MSM. However, symptomatic disease is not well reported. Aims/objectives We describe a case of symptomatic rectal mycoplasma genitalium Methods Retrospective case not review Results A 19 year old MSM attended with a 2 week history of rectal bleeding, discharge and tenesmus. His last sexual contact was 6 weeks previously: condom-less receptive anal intercourse. On examination, he had no lymphadenopathy, no rash and no evidence of oral ulceration. On proctoscopy, he had erythematous mucosa and multiple small discrete rectal ulcers. Triple site swabs were taken including gonorrhoea culture, rectal swab for LGV and multiplex PCR (syphilis, HSV and mycoplasma genitalium). A full blood borne virus screen was performed. He was treated with ceftriaxone (500 g IM), azithromycin (1 g PO), doxycycline (100 mg PO BD for 7 days) and acyclovir (400 mg PO TDS for 5 days) but his symptoms did not resolve. All tests were negative except rectal multiplex PCR was positive for mycoplasma genitalium. He was diagnosed as having symptomatic mycoplasma genitalium infection and was treated with a prolonged course of azithromycin. His symptoms subsided. Discussion/conclusion Mycoplasma genitalium has been found in the rectum of MSM and is usually asymptomatic. We describe a case of proctitis which seems to be related to Mycoplasma genitalium. MSM with unresolved proctitis should be tested for Mycoplasma genitalium.

G78(P) The Youngest Child with Familial Polyposis Coli

AimsFamilial adenomatosous polyposis (FAP) is an autosomal dominant condition characterised of the development of large numbers of colorectal adenomatous polyps. The average age of onset of polyposis is 16 years,...

Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer

Objective. To evaluate the value, risks, and shortcomings of immunochemical faecal occult blood tests (iFOBTs) in the diagnosis of colorectal cancer (CRC) and adenomas with high-grade dysplasia (HGD) in patients initially presenting to primary care. Design. A retrospective population-based study. Setting and subjects. All 495 cases of CRC and adenomas with HGD diagnosed in the county of Jämtland, Sweden from 2005 to 2009. Results. Of 495 patients 323 (65%) initially presented to primary care. IFOBTs were performed in 215 of 323 (67%) patients. The sensitivity of iFOBT for CRC and adenomas with HGD was 88% (83% when patients with a history of rectal bleeding were excluded). Of 34 patients with anaemia found en passant, 10 had negative iFOBTs. Time to diagnosis was longer for patients with negative iFOBTs (p < 0.0005). Conclusion. IFOBT might be helpful in selecting which patients to refer for colonoscopy. However, iFOBT has a limited sensitivity as a diagnostic test for CRC and adenomas with HGD. Relying only on iFOBT for colonoscopy referral could delay diagnosis, especially for patients with anaemia found en passant.

Metastasis of Rectal Carcinoma in Testes and Skin: Case Series

Most common sites for metastasis of rectum carcinoma are liver, lung, and peritoneum. Cutaneous and testicular metastasis from rectum is rare. Cutaneous metastasis from colorectal cancer occur less than 4%of patients [1]. The occurrence of cutaneous metastatic disease from colorectal cancer is uncommon and typically signifies widespread disease with poor prognosis [2]. Testicular metastases from colorectal cancers are rare. Metastatic carcinoma of testes are reported in 0.02 % to 2.5 % [3, 4]. Most common sites for primary are prostate [60 %], Melanoma [15 %], and sarcoma [10 %]. Rarely it metastasises from colon and rectum [5 %] [5]. Unusual site metastases of colorectal cancer are rarely detected in clinical practice. Here we report 4 patients of rectal malignancy having unusual site metastasis (Table 1). Table 1 Details of patients Case 1 In this case patient presented with chief complaint of skin nodules on chest and left side of neck since one month (Fig. ​(Fig.1).1). These swellings were mobile, firm, 1–2 cm in size. On histopathological examination Section showed stratified squamous epithelium infiltrated by malignant epithelial tumour cells dispersed in acini as well as tubules. Some of tumour cells show in intracytoplasmic mucin. Few signet ring cells were also evident. On IHC stainng-Primary panel of CK-7 and CK-20 was applied. Tumors showed positive for CK-20 and negative for CK-7and subsequently CDX 2 which was also positive. Thereby confirmed the diagnosis of metastasis from colorectal carcinoma. On further detail history there were altered bowel habit and weight loss but no history of rectal bleeding. Proctoscopic Examination showed a growth in lower rectum and guided biopsy showed infiltrating mucinous adenocarcinoma (signet ring type) of rectum. CECT abdomen showed single metastasis inside the liver. CECT chest was normal. Serum CEA level was 16 ug/L. Patient was on Chemotherapy (FOLFOX 4). Patient succumbed to death after 4 months from time of appearance of skin nodule. Fig. 1 Showing metastatic nodules on neck and chest Case 2 This patient was diagnosed as a case of stage II rectal cancer. Abdominoperineal resection(APR) was done and was on adjuvant chemotherapy. Patient developed skin swellings at upper end of abdomen, chest and on neck after 10 month of surgery. On Excisional biopsy section showed skin lining infiltrated by tumour cells forming glands and acini lined by tumpur cells having high nucleo cytoplasmic ratio, vesicular nuclei and prominent nucleoli and moderate cytoplasm cytoplasm. Few mitotic figures also evident. On IHC staining it was positive for CK-20 and negative for CK-7 and subsequently CDX 2 was also positive. So Metastatic adenocarcinoma arising from colorectal carcinoma was confirmed. Patient died after 18 months of surgery and after 8 months from time of appearance of skin swellings.