Mucin-secreting Adenocarcinoma Research Articles

Distribution Patterns of Morphologies of Colorectal Carcinoma: A Descriptive, Cross-Sectional Study

Background: Colorectal malignancies are one of the commonest cancers throughout the world which is often diagnosed at advanced stages. Several lifestyle factors contribute to the development of this cancer such as a high intake of processed meats and low intake of fruits and vegetables, sedentary lifestyle, obesity, smoking and excessive alcohol consumption. Methods: This cross-sectional study was conducted in BIRDEM General Hospital in Dhaka in the Department of Pathology with 109 resected colectomy specimens during the period of March 2020 to February 2022. Relevant findings were recorded and analyzed for determining the morphological characteristics based on histopathological types, grading and staging of the malignancy. Results: Maximum patients belonged to 51-60 years of age; were males, hailing from urban regions and found to indulge in smoking. Per rectal bleeding, alteration of bowel habits and abdominal pain were the most frequently reported clinical symptoms. The commonest areas of occurrence of the tumors were rectum, recto-sigmoid junction and caecum. Out of all the 109 cases, 48, 45 and 16 belonged to non-mucinous, mucinous and signet-ring types as per histological classification respectively. Among these, 39 of non-mucinous and 24 of mucinous types belonged to Dukes’ B staging whereas 11 of the signet-ring variants fell in Dukes’ C stage. Regarding grading, maximum patients, meaning 68 out of 109, belonged to Grade II. After performing Fisher’s exact test, associations between staging and grading, grading and types and types and grading were found statistically significant. Conclusion: Colon and rectal mucin-secreting and signet-ring cell adenocarcinomas are high grade cancers that usually show up at an advanced stage.

Mucin-secreting Adenocarcinoma of the Appendix Presented as Abdominal Lump with Distension: A Case with Diagnostic Dilemma

Appendicular adenocarcinoma is a rare tumour, and the mucin variety is common. It is usually presented with symptoms such as abdominal pain, abdominal tenderness, nausea, vomiting, change in bowel habits, and unexplained weight loss. These symptoms can resemble those of other clinical conditions, making the diagnosis of appendicular adenocarcinoma challenging. Screening modalities such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT) imaging, Contrast-Enhanced Computed Tomography (CECT), blood tests, and histopathological analysis can help confirm the diagnosis. This case is reported to highlight the unusual presentation and diagnostic difficulties associated with appendiceal adenocarcinoma. A 48 years old female patient presented with complaints of dull, continuous abdominal pain for the past six months, along with an abdominal lump and distension, without any other associated symptoms. Laboratory investigations for Cancer Antigen 125 (CA 125), β-Human Chorionic Gonadotropin (HCG), and α-fetoprotein were found to be within normal limits. Further, CECT imaging was suggestive of mucin-secreting adenocarcinoma of ovarian origin. The final diagnosis was confirmed by histopathological analysis as mucinsecreting adenocarcinoma of the appendix with pseudomyxoma peritonei and was managed through cytoreduction surgery.

Mixed neuroendocrine-non neuroendocrine neoplasm of the colon

Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is a rare diagnosis in which neuroendocrine component is combined with a non-neuroendocrine component, each of which is morphologically and immunohistochemically recognisable as a discrete component and constitute ≥30% of the neoplasm. This case study reports two elderly patients with MiNEN in their colon, the first presented with caecal tumour on colonoscopy and the second had an obstructing mass in hepatic flexure region. They underwent hemicolectomy which revealed similar morphological findings which showed high grade adenocarcinoma in the superficial part and poorly differentiated components with signet rings and extracellular mucin in the deeper aspects. Areas of rhabdoid differentiation is also present in the first patient. Grade 3 neuroendocrine component is well defined within the deep aspect and constitute about 30% of the tumour. These components are positive for synaptophysin and focally for chromogranin with high Ki67. Perineural and lymphovascular invasion is identified in both cases along with metastasis to regional lymph nodes. MiNEN has an aggressive biological behaviour, mostly driven by its (often high-grade) neuroendocrine component, and a dismal prognosis. In summary, we are discussing two cases of MiNEN with poorly differentiated mucin secreting adenocarcinoma and grade 3 neuroendocrine tumour. 1.Frizziero M, Chakrabarty B, Nagy B, et al. Mixed neuroendocrine non-neuroendocrine neoplasms: a systematic review of a controversial and underestimated diagnosis. J Clin Med 2020; 9: 273.2.WHO Classification of Tumours Editorial Board. WHO Classification of Tumours: Digestive System Tumours. 5th ed. Lyon: IARC, 2019.3.de Mestier L, Cros J, Neuzillet C, et al. Digestive system mixed neuroendocrine-non-neuroendocrine neoplasms. Neuroendocrinology 2017; 105: 412–25.

A Case of Aspergilloma with Mucin Secreting Adenocarcinoma in the Cavity Wall

A Pulmonary aspergillosis and lung cancer rarely occur simultaenously. We report a 63 year old female with complaint of heamoptysis. Contrast enhanced chest revealed a cavity containing fungus ball in the left lung lower lobe suggestive of a fungoma. Left lower lobectomy was done for intractable heamoptysis. The histological examination of the reselected specimen showed colonies of aspergilli in the cavity and mucin secreting adenocarcinoma in the cavitary wall. Careful gross examination of the patient must be done to rule out metastasis.SAARC J TUBER LUNG DIS HIV/AIDS, 2015; 12(1), Page: 39-41

PTH-276 Adenocarcinoma of rectum – a composite of 3 different subtypes with varying outcomes?

<h3>Introduction</h3> Considerable confusion exists with regards to the terminology of mucin secreting adenocarcinomas of the rectum. The WHO classification system needs to be followed accurately for comparing the outcomes of mucinous and signet ring cell carcinomas. We hypothesised that clinico-pathological outcome measures like margins, tumour regression grade, recurrence rates and survival vary with histology. <h3>Method</h3> We conducted a retrospective analysis of a prospectively maintained database. All Stage I-III rectal adenocarcinoma patients were included. <h3>Results</h3> Between May 2010 and August 2013, 273 patients underwent curative resection. Both the mucin secreting variants were more common in young age and presented at a more advanced stage.14%of tumours had signet ring cell histology whereas 8% had mucinous histology. 54% and 48% of signet ring cell carcinoma (SRCC) and mucinous adenocarcinoma (MAC) patients were node positive in contrast to the classical variant (30%). CRM positivity was 24% with MAC and 19% with SRCC as compared to 4% with the classical variant. The DFS among the classical and mucinous variants was 38.5 and 37.4 months, respectively, whereas it was 28.6 months in the SRCC group. OS did not differ significantly. <h3>Conclusion</h3> There is a high incidence of aggressive mucin secreting variants in India. There exists a spectrum of adenocarcinomas of rectum with progressively worsening outcomes from classical to MAC to SRCC. These aggressive variants might warrant more aggressive resections. <h3>Disclosure of interest</h3> None Declared.

The Spectrum of colonic lesions: A Clinico-pathological study of colonic biopsies

Background: The colon is a seat for various diseases which include both non neoplastic and neoplastic conditions, with some of the inflammatory diseases being premalignant. The endoscopic evaluation of the large bowel has helped in not only direct visualisation of these lesions but also in taking a biopsy for histopathological diagnosis which also helps in the further assessment and treatment of the patient. Colonoscopy is also considered gold standard for cancer surveillance, which is the third prevalent cancer in men and women.23Thus colonoscopic biopsy is an important tool in the diagnosis of large bowel diseases. Objectives: To study the spectrum of lesions of colon in conjunction with clinical data and to evaluate the histomorphology of colonoscopic biopsies. Materials and Methods: All colonoscopic biopsies received in Department of Pathology, of a tertiary health care centre during a three year study period ,i.e from August 2012 to August 2014, were subjected to histopathological study and data analysed. Results: A total of 159 colonoscopic biopsies were studied. Out of them, 68 (42.8%) were non neoplastic, 23 (14.4%) were benign lesions and 68 (42.8%) were malignant lesions. Among the 68 Non neoplastic lesions, 32 cases were non-specific colitis, 11 cases ulcerative colitis, 5 cases juvenile polyps, 5 cases hyperplastic polyps, 4 cases SRUS, 3 cases granulomatous inflammation,3 cases retention polyp, 2 cases Crohn’s disease and one case each of acute inflammation, inflammatory polyp and endometriosis. Out of the 23 benign cases, 18were tubular adenomas (78.3%); 3 were villous adenomas (13%); 1 case of tubulovillous adenoma (4.3%) and 1 case of Benign spindle cell lesion (4.3%).Out of 68 malignant lesions, 24 cases(35.3%) were Well differentiated Adenocarcinoma, 25 cases (36.8%) were Moderately differentiated Adenocarcinoma, 9 cases (13.2%) were Poorly differentiated, 8 cases (11.8%) were Mucin secreting Adenocarcinoma an

Nonbacterial Thrombotic Endocarditis in Association with Metastatic Mucin-Secreting Adenocarcinoma in Heart

Nonbacterial thrombotic endocarditis (NBTE) is characterized by the deposition of thrombi on cardiac valves in the absence of bloodstream bacterial infection. It is usually associated with advanced stage malignancy and chronic debilitating diseases. We present an autopsy case report of a 45-year-old man with NBTE in association with metastatic mucin-secreting adenocarcinoma involving the heart.

Nodular mesenteric panniculitis of rectum simulating malignancy

Mesenteric panniculitis is a benign fibroinflammatory process involving adipose tissue of the mesentery. We report a case of a 62 year old male who showed signs of partial bowel obstruction and whose computed tomography of abdomen showed nodular soft tissue densities around the sigmoid junction. Distal colectomy was planned and laparotomy was performed. Anal skin, rectum and sigmoid colon was resected. Microscopic pathologic sections from the serosal nodule showed histo morphologic features of panniculitis while overlying mucosa showed tumor consisting of mucin secreting adenocarcinoma.

Colitis Cystca Profunda causing colo-colic intussusceptions in an adult

A 62 years old male with colo-colic intussusception caused by colitis cystica profunda is reported. Patient was admitted with features of complete intestinal obstruction. Patient had the history of altered bowel habits and per rectal discharge of altered blood and mucous for six months. Contrast enhanced CT abdomen showed a transverse colonic mass with colocolic intussusception. With provisional diagnosis of carcinoma colon as a causative lesion, left radical hemicolectomy was performed. Intussuscepted segment had colitis cystic profunda histopathologically. The diagnosis of this entity is important as it can mimic mucin-secreting adenocarcinoma and therefore may result in radical surgical resection

Combined adenocarcinoma-carcinoid tumor of transverse colon

A 65-year-old male presented with painless hematochezia associated with episodic cramps in upper abdomen, watery diarrhea, and a slowly growing mass in upper abdomen. Examination revealed a firm 6 x 5 cm, intra-abdominal, epigastric mass. Colonoscopy up to 90 cm showed a stenosing, ulcero-proliferative lesion in the transverse colon. No synchronous lesion was detected. Biopsy revealed mucin secreting adenocarcinoma. Exploration showed the growth involving the transverse colon proximal to the splenic flexure with a part of ileum, approximately three feet proximal to ileo-caecal junction, adherent to it. No significant mesenteric lymph node enlargement was evident. The patient underwent resection of the growth along with the segment of adherent ileum. Continuity was re-established by a colo-colic and ileo-ileal anastomosis respectively. Patient received adjuvant chemotherapy. Post-operative histopathology demonstrated a composite histological pattern with an admixture of carcinoid tumor and adenocarcinoma, invasion of ileal serosa and adenocarcinomatous deposits in mesocolic lymph nodes, the tumor staging being (T4, N0, M0/Stage II) for carcinoid and (T4, N1, M0/Stage III) for adenocarcinoma. Patient was followed-up for a year and was doing well without any evidence of recurrence.

Severe bone pain as first presentation of gastric malignancy

Gastric cancer still accounts for significant cancer mortality world-wide. It generally occurs at advanced ages in most parts of the world but reports in Nigeria so far indicates that gastric carcinoma is seen in younger ages. Most cases of gastric cancer present late; with weight loss, abdominal pain/swelling, anorexia, and vomiting with or without hematemesis. Presentation with bone pains is uncommon. We report a 23-year-old female Nigerian who presented with generalized bone pain with limitation of movement, use of non-steroidal anti-inflammatory drugs and recurrent hematemesis. She was resuscitated and further evaluation revealed; anemia, hypercalcaemia, and X-ray osteolytic lesions, suggestive of multiple myeloma. Bone marrow aspiration cytology however, showed heavy infiltration with clusters of abnormal cells suggestive of mucin secreting adenocarcinoma. Upper gastrointestinal endoscopy revealed gastric tumor, histologically confirmed to be a poorly differentiated adenocarcinoma. Gastric cancer typically presents late and in advanced stages. Typical symptoms may include, weight loss, abdominal pain, vomiting, and hematemesis. It may however present with metastasis to the bone and present with bone pains. It is recommended that evaluation of patients with bone pain should include upper gastrointestinal endoscopy especially, where anemia or upper gastrointestinal bleeding is co-existent.

Colorectal cancer in young adults in a tertiary care hospital in Chhattisgarh, Raipur

Carcinoma of the colon and rectum is a relatively uncommon malignancy in India when compared with the western world. Colorectal cancer is generally a disease affecting individuals 50 years of age and older and is much less common in persons under 40 years of age. It is also a very uncommon pediatric malignancy. To study the age, gender, site of primary tumor, histopathological type, and pathologic stage of colorectal cancer cases with specific reference to young adults. Tertiary care hospital, Retrospective study. We conducted a retrospective study of all colorectal carcinomas (CRC) which were diagnosed during the past 8 years i.e., from January 2003 to December 2010. Patients were divided in to two groups - 40 years and younger, and older than 40 years. The records were analyzed in detail for age, gender, site of primary tumor, histopathological type, and pathologic stage. The results of the two groups were compared and also with information from other centers. Nil. Two hundred and thirty three patients were diagnosed to have CRC. Patients diagnosed below 40 years of age comprised 39.05% and those under age 20 comprised 4. 29%. Among those under 40 years of age, majority were males (63.73%), most occurred in the rectum (84.61%). Most of them were poorly differentiated mucin-secreting adenocarcinomas (80.21%) and presented at advanced pathologic T stage (71.42%). This was similar to those reported in other literatures. However, the incidence of colorectal cancer in patients younger than 40 years is much more in our study when compared with reports from other places. CRC in our institution is more often seen in younger individuals than what is reported in population-based cancer registries from other parts of the country. The reasons for this are not clear. Therefore, further studies are required to address the role of diet and personal habits with CRC in this region. Also, a high index of suspicion among young adults is necessary.

Uterine Cervix Metastasis from Primary Colorectal Carcinoma: a Report of Two Cases with Review of Literature

A 26-year-old female presented with complaints of bleeding per rectum for 6 months. Per rectal examination revealed growth in lower third of rectum. Complete gynecological examination was performed followed by cytological analysis of uterine cervix cell smear and all findings were normal. Lower gastrointestinal endoscopy (LGIE) was suggestive of 5 cm ulcerative growth in the rectal area. Contrast-enhanced computed tomography (CECT) showed circumferential thickening of rectal wall with a length of 5 cm with an eccentric growth on right rectal wall with maximum wall thickness of 10 mm. Biopsy was suggestive of moderately differentiated mucin-secreting adenocarcinoma. Hence, patient was diagnosed with rectal cancer. She was treated with neoadjuvant chemoradiation with 45 Gy in 25 fractions and weekly chemotherapy with 5-FU and leucovorin. The patient then underwent low anterior resection with total mesorectal excision. Pathological examination found a moderately differentiated adenocarcinomawith serosal involvement. Perineural spread and lymphovascular emboli were present; however, lymph nodes dissected were free of tumor. She was pathologically staged as pT4aN0M0. She was then treated with six cycles of adjuvant chemotherapy with FOLFOX. CECT at 1-month post-completion of chemotherapy and at 4 months did not reveal any abnormality. Eight months later, she camewith complaints of postcoital bleeding and leucorrhea. On pelvic examination, an ulceroproliferative growth was found at cervix which was involving all fornices and upper half of all vaginal walls. Biopsy was suggestive of metastatic adenocarcinoma with mucin-secreting features. Immunohistochemistry (IHC) performed showed positivity of tumor cells for CK20 and negative for CK7, confirming metastasis from colorectal primary (Fig. 1a). PET-CT showed a lesion in the cervix with parametrial infiltration and loss of fat planes between lesion and bladder. As the patient was not a candidate for surgery in view of the involvement of vaginal walls, so she was started on secondline chemotherapy with FOLFIRI regimen. Chemotherapy was stopped after three cycles due to progression of disease and intolerance. The patient died of progressive disease.

Gastric adenocarcinoma associated with lymphangitis carcinomatosa, adrenal metastasis with ectopic ACTH syndrome and malignant common bile duct stricture

Ectopic adrenocorticotrophic hormone (ACTH) syndrome (EAS) commonly occurs secondary to neuroendocrine tumours and small cell carcinoma of lung. EAS has also been reported in association with gastric carcinoids. But, the occurrence of EAS secondary to gastric adenocarcinoma has rarely been reported. A 45-year-old male patient from Bangladesh presented with abdominal pain, jaundice and hyperpigmentation. Extensive work-up revealed poorly differentiating mucin-secreting adenocarcinoma of stomach with lymphangitis carcinomatosa of lung, bilateral adrenal metastasis and malignant common bile duct (CBD) stricture. Laboratory reports were suggestive for ectopic ACTH production. Most of these features are very rare in adenocarcinoma of stomach, and all these rare events occurring in a single patient is probably the rarest.

Colorectal carcinoma in a ten-year-old girl: A case report

Colorectal carcinoma is very rare in childhood. In this case report, we depict a ten-year-old girl who presented with features of intestinal obstruction which turned out to be due to poorly differentiated mucin secreting adenocarcinoma of descending colon. Only increased awareness of this malignancy in this age-group and a high index of suspicion can help when a child complains of persistent pain of abdomen, altered bowel habits or rectal bleeding, and may provide diagnosis at an earlier stage, thereby improving the prognosis.

Occult mucin secreting adenocarcinoma of gall bladder with metastasis to urinary bladder

Mucin secreting adenocarcinoma of the gall bladder is rare. Although it has propensity to metastasise, urinary metastasis is extremely unusual. We report a case with mucin secreting adenocarcinoma of the gall bladder with metastasis to the urinary bladder. To the best of our knowledge, this is the first case of its kind in the literature.

Adenocarcinoma in Retroperitoneal Teratoma

We report a rare case of adenocarcinoma in retroperitoneal teratoma in a 38year old female patient who attended surgical OPD with complaints of dragging pain and heaviness in left lumbar region. Straight x-ray abdomen showed few irregular calcifications in left lumbar region. USG and CT showed it to be adrenal tumor and retroperitoneal teratoma respectively. Excised specimen confirmed it as mucin secreting adenocarcinoma in a case of retroperitoneal teratoma.

Adenocarcinoma de uraco con metástasis cerebrales tardías

To describe a case of urachal adenocarcinoma with late brain metastases in a sixty one year old man who presented abdominal discomfort and hematuria during six months. The clinical suspicion was bladder tumor and diagnostic studies were performed (urinary cytology, cystoscopy, abdominal ultrasound and abdominopelvic CT scan). Surgical treatment was performed. Negative urinary cytology. Cystoscopy showed a lesion with infiltration of the bladder dome. Ultrasound and CT scan showed a five centimeter rounded lesion, with intermediate density, internal echoes and calcifications on the anterior supravesical middle line, that infiltrated the bladder. The extension study had not findings. Partial cystectomy and lymphadenectomy were performed. The histopathologic diagnosis was mucin-secreting urachal adenocarcinoma. After five years without disease the patient suffered lung and brain metastases. Urachal adenocarcinoma is a tumor which must be distinguished of primary bladder adeno-carcinoma. The mucing-secreting adenocarcinoma can be associated with calcifications that can be demostrated on imaging studies. Late metastases without signs of local recurrence (after five years without disease) are an infrequent clinical-pathologic finding.

Bone metastasis of glandular cardiac myxoma mimicking a metastatic carcinoma

Skeletal metastasis from a cardiac myxoma is rare. We describe an extremely unusual case of a cardiac myxoma metastasing to the femur in a 46-year-old female presenting with pain in the right hip. Radiographs showed an expansile lytic lesion with pathological fracture involving the neck and proximal shaft of the right femur. Histology revealed features of cardiac myxoma with heterologous glandular elements, which was initially mistaken for a metastatic mucin-secreting adenocarcinoma.

Adenocarcinoma of the Colon in a 10-year-old child

Colonic adenocarcinoma is rare in children, more so in the first decade of life. Owing to the non-specificity and vagueness of symptoms, most patients in this age group present with advanced malignacy. The authors report a case of adenocarcinoma of the colon in a 10-year-old female child presenting with a history of abdominal pain, distention and constipation. Barium enema highlighted a narrowing of the distal ascending colon with laparotomy revealing a growth involving the caecum and ascending colon. Histology confirmed it as a poorly diffentiated mucin secreting adenocarcinoma. A right hemicolectomy with end to end ileo-transverse anastomosis was perfomed. Four months later, she presented with symptoms of intestinal obstruction. Intraoperatively, widespread metastatic nodules with recurrent tumour were noted. It is important for clinicians to be aware that colorectal carcinoma does occur in children, and age alone should not be a basis for its exclusion. This case is presented to draw attention to a disease in which the prognosis, by wider recognition of its occurrence in childhood, might be improved.