Journal of Pathology and Translational Medicine

Case Report

Rectal Invasion by Prostatic Adenocarcinoma That Was Initially Diagnosed in a Rectal Polyp on Colonoscopy: Ghilsuk Yoon, Man-Hoon Han, An Na Seo; J Pathol Transl Med. 2019;53(4):266-269. Published online April 11, 2019; DOI: https://doi.org/10.4132/jptm.2019.03.25

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Despite anatomical proximity, prostatic adenocarcinoma with rectal invasion is extremely rare. We present a case of rectal invasion by prostatic adenocarcinoma that was initially diagnosed from a rectal polyp biopsied on colonoscopy in a 69-year-old Korean man. He presented with dull anal pain and voiding discomfort for several days. Computed tomography revealed either prostatic adenocarcinoma with rectal invasion or rectal adenocarcinoma with prostatic invasion. His tumor marker profile showed normal prostate specific antigen (PSA) level and significantly elevated carcinoembryonic antigen level. Colonoscopy was performed, and a specimen was obtained from a round, 1.5 cm, sessile polyp that was 1.5 cm above the anal verge. Microscopically, glandular tumor structures infiltrated into the rectal mucosa and submucosa. Immunohistochemically, the tumor cells showed alpha-methylacyl-CoA-racemase positivity, PSA positivity, and caudal-related homeobox 2 negativity. The final diagnosis of the rectal polyp was consistent with prostatic adenocarcinoma. Here, we present a rare case that could have been misdiagnosed as rectal adenocarcinoma.

Citations

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Prostate cancer invading rectal serosa and anal sphincter treated with definitive radiation therapy: Case report and review of the literature
Mi-Jo Lee
Journal of Cancer Research and Therapeutics.2024; 20(3): 1081. CrossRef
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Zakaria W Shkoukani, Alaa Chamsin, Mohamed I Abdulmajed
Cureus.2024;[Epub] CrossRef
An Interesting Case of Prostate Cancer Presenting With Colonic Metastasis
Shawn Keating, Ayesha Imtiaz, Kenneth Nahum, Ankita Prasad, Pramil Cheriyath
Cureus.2023;[Epub] CrossRef
Metastase d’un adenocarcinome prostatique au sein d’un polype colique. À propos d’un cas et revue de la littérature
Guillaume Abitbol, Clémence Barthomeuf, Olivier Varennes, Marine Clement, Sami Hakim, Denis Chatelain
Annales de Pathologie.2023; 43(4): 342. CrossRef
Isolated Rectal Metastases from Locally Advanced Carcinoma Prostate Detected by 18F-PSMA-1007 PET/CT
Shashank Shekhar Singh, Rani Kunti Randhir Singh, Narvesh Kumar, Harshvardhan Atrey
World Journal of Nuclear Medicine.2022; 21(03): 248. CrossRef
Rectal Invasion by Metastatic Prostate Adenocarcinoma
Anshu Wadehra, Samer Alkassis, Aliza Rizwan, Omid Yazdanpanah
Cureus.2021;[Epub] CrossRef
Metastatic Prostate Cancer Presenting as a Rectal Polyp: A Rare Occurrence
Ese Uwagbale, Ifeanyichukwu Onukogu, Vimal Bodiwala, Solomon Agbroko, Niket Sonpal
Cureus.2021;[Epub] CrossRef
Local Staging of Prostate Cancer with Multiparametric MRI
Nandan Keshav, Mark D. Ehrhart, Steven C. Eberhardt, Martha F. Terrazas
Seminars in Roentgenology.2021; 56(4): 366. CrossRef

Case Study

Rhabdoid Colorectal Carcinomas: Reports of Two Cases: Sang Hwa Lee, Hyesil Seol, Wook Youn Kim, So Dug Lim, Wan Seop Kim, Tae Sook Hwang, Hye Seung Han; Korean J Pathol. 2013;47(4):372-377. Published online August 26, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.4.372

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Abstract PDF

Rhabdoid colorectal carcinomas are very rare and only 10 cases have been previously reported. We report two cases of rhabdoid colorectal carcinoma, one arising in the sigmoid colon of a 62-year-old man and another in the rectum of an 83-year-old woman. In both cases, the patients had advanced tumors with lymph node metastases. The tumors mostly showed a diffuse arrangement with rhabdoid features and small glandular regions were combined. Transitional areas from the adenocarcinomas to the rhabdoid tumors were also noted. Adenocarcinoma cells were positive for mixed cytokeratin (CK), CK20 and epithelial membranous antigen (EMA), but focal positive for vimentin. The rhabdoid tumor cells were positive for mixed CK, but focal positive or negative for CK20 and EMA. In addition, they were diffusely positive for vimentin, but negative for desmin. The histological and immunohistologial findings of these two cases suggest that the rhabodid tumor cells originated from dedifferentiated adenocarcinomas.

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International Journal of Surgical Pathology.2024; 32(1): 187. CrossRef
Emerging and under-recognised patterns of colorectal carcinoma morphologies: a comprehensive review
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A Rare Case of Undifferentiated Rhabdoid Carcinoma of the Colon
Syed Alishan Nasir, Ronak Patel, Lalaine Ruiz, Michael Bush
Cureus.2022;[Epub] CrossRef
INI1-negative colorectal undifferentiated carcinoma with rhabdoid features and postoperative rapidly growing liver metastases: a case report and review of the literature
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Yuya Ashitomi, Mitsuhiro Yano, Michihisa Kono, Takefumi Suzuki, Ichiro Kawamura, Shinji Okazaki, Yukinori Kamio, Osamu Hachiya, Yuka Urano, Fuyuhiko Motoi
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BRAF Mutation in Colorectal Rhabdoid and Poorly Differentiated Medullary Carcinomas
Elena Bolzacchini, Nunzio Digiacomo, Cristina Marrazzo, Nora Sahnane, Roberta Maragliano, Anthony Gill, Luca Albarello, Fausto Sessa, Daniela Furlan, Carlo Capella
Cancers.2019; 11(9): 1252. CrossRef
Pathologic complete response to bevacizumab-FOLFIRI in metastatic colonic undifferentiated carcinoma with rhabdoid features
Tien-Chan Hsieh, Hung-Wei Liu, Chao-Wen Hsu
Journal of Cancer Research and Practice.2019; 6(3): 140. CrossRef
Extraordinary disease-free survival in a rare malignant extrarenal rhabdoid tumor: a case report and review of the literature
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Tumor rabdoide extrarrenal maligno de colon: presentación de 3 casos y revisión de la literatura
María José Sánchez-de las Matas Garre, José García Solano, Pablo Conesa Zamora, Fidel Fernández Fernández, Miguel Pérez-Guillermo
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Poorly differentiated cecal adenocarcinoma showing prominent rhabdoid feature combined with appendiceal mucinous cystadenoma: A case report and review of the literature
IN-JU CHO, SUNG-SOO KIM, YOUNG-DON MIN, MUN-WHAN NOH, RAN HONG
Oncology Letters.2015; 9(4): 1527. CrossRef
A Rare Case of Undifferentiated Carcinoma of the Colon with Rhabdoid Features: A Case Report and Review of the Literature
E. Moussaly, J. P. Atallah
Case Reports in Oncological Medicine.2015; 2015: 1. CrossRef
Case Report of Rhabdoid Colon Cancer and Review of Literature
Aparna Kalyan, Gurleen Pasricha, Dulabh Monga, Aatur Singhi, Nathan Bahary
Clinical Colorectal Cancer.2015; 14(1): e5. CrossRef
Malignant Rhabdoid Tumor of the Colon: A Case Report
Elena Romera Barba, Ainhoa Sánchez Pérez, Carlos Duque Pérez, José Antonio García Marcilla, José Luis Vázquez Rojas
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Tumor rabdoide maligno de colon: a propósito de un caso☆
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Original Article

SSTR2A Protein Expression in Neuroendocrine Neoplasms of the Colorectum.: Young Eun Kim, Jeeyun Lee, Young Suk Park, Kyoung Mee Kim; Korean J Pathol. 2011;45(3):276-280.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.3.276

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Abstract PDF: BACKGROUND
Expression studies of somatostatin receptor type 2A (SSTR2A) in neuroendocrine neoplasms (NENs) led to the development of clinically relevant diagnostic and therapeutic strategies. However, most of these strategies used in-house-developed antibodies and were focused on lung tumors. We evaluated commercially available SSTR2A antibodies in NENs of the colorectum to observe their subcellular localization and distribution within the resected tumor.
METHODS
The immunohistochemistry of 77 NENs located in the colorectum were studied using a commercially available antibody against SSTR2A.
RESULTS
Most neuroendocrine tumors (NET) grade (G)1 and G2 expressed the SSTR2A in the cytoplasm with apical or luminal localization. However, all neuroendocrine carcinomas (NEC) G3 were negative for SSTR2A.
CONCLUSIONS
Our data indicate that SSTR2A immunohistochemistry shows cytoplasmic staining with distinct subcellular localization in most NET G1 in the colorectum using a commercially available antibody. Low or no expression of SSTR2A in NET G2 and NEC G3 raises the possibility that SSTR2A may correlate with histologic differentiation and proliferative activity. Further validation studies in large case series are needed.

Case Reports

Metastases from Rectum and Thyroid Cancers in Same Cervical Lymph Node: A Case Report.: Bulent Yildiz, Abdulkadir Reis, Evren Fidan, Feyyaz Ozdemir, Halil Kavgaci, Fazil Aydin; Korean J Pathol. 2010;44(5):551-553.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.5.551

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Abstract PDF: An excisional biopsy targeting a cervical lymph node was performed on a 49-year-old female patient with metastatic rectal cancer. The biopsy revealed rectal and papillary thyroid cancer metastasis in the same lymph node. A thin-needle thyroid aspiration biopsy was performed, and the result was papillary thyroid carcinoma. The patient, who received chemotherapy for the metastatic rectal cancer, died due to disease progression about 5 months after a secondary primary tumor was detected. Metastasis of multiple malignancies in the same lymph node is extremely rare. A metastases of rectal and thyroid cancers to the same lymph node has not been reported until now. Our patient is the first case in the literature.

Mature Teratoma of the Rectum: A Case Report.: Kyung Sun Park, Mi Seon Kang, Young Ju Kim, Chan Hwan Kim, Hye Kyoung Yoon; Korean J Pathol. 2001;35(1):83-85.

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Abstract PDF: Teratoma commonly affects the gonads. Its occurrence in extragonadal sites has also been reported. However, teratoma affecting the gastrointestinal tract is extremely uncommon. Herein, we describe a rare case of rectal teratoma presenting a solid polypoid tumor. A 61-year-old woman with constipation is presented. She had a colonoscopic examination and was noted to have a pedunculated polyp at the rectum, located 15 cm from the anal verge. The 4.2x2.4x2.0 cm polyp arose at the rectal mucosa which had a long stalk and smooth surface. The cut surface showed a solid area with a central yellow area. Microscopically, the polyp was covered with keratinizing stratified squamous epithelium which was abruptly exchanged from the columnar rectal mucosa. Sebaceous glands, sweat glands and hair follicles were mixed in stroma under the surface of the polyp. The central portion of the polyp was composed of mature adipose tissue and collagen fibers. Mature neural elements were noted in the stalk.

Isolated Polypoid Ganglioneuroma in the Rectum.: Se Hoon Kim, Chang Hwan Choi, Yong Han Paik, Won Ho Kim, Hoguen Kim; Korean J Pathol. 2001;35(4):344-346.

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Abstract PDF: Gastrointestinal ganglioneuroma is a rare benign neoplasm, composed of ganglion cells, nerve fibers, and supporting cells. Ganglioneuromas are presented as isolated polypoid ganglioneuroma, ganglioneuromatous polyposis, and diffuse ganglioneuromas. We have experienced a case of an isolated ganglioneuromatous polyp in the rectum. The patient was a 58-year-old female who had experienced low abdominal discomfort and tenesmus for 6 to 7 months. Colonoscopic examination revealed a polypoid tumor in the rectum. Microscopically, the tumor showed cystic glands, expanded lamina propria, and smooth surface epithelium. Many proliferated ganglion cells with nerve fibers were evident in the lamina propria which was extended to the submucosa.

Histiocytic Sarcoma of Rectum: A Case Report.: Moon Il Park, Kyu Sang Song, Dae Young Kang; Korean J Pathol. 2006;40(2):156-159.

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Abstract PDF: We present a case of a 44 year-old man with histiocytic sarcoma arising from the rectum. Histiocytic sarcoma is a rare type of malignant lymphoma, comprising less than 0.5% of all non-Hodgkin's lymphomas (NHLs). In this case, the tumor was a polypoid mass, measuring 2.5 x 2 cm. On microscopic examination, it was composed of many bizarre multinucleated cells and sheets of xanthomatous histiocytes. There were also areas with spindle cells arranged in a storiform pattern. Extensive metastases to regional lymph nodes were found, and combined adjuvant chemotherapy was administered after complete resection.

Original Articles

Prognostic Implications of DNA Ploidy and S-phase Fraction Comparing with Other Prognostic Factors in Advanced Coloretal Adenocarcinomas .: Young Il Yang, Jong Eun Joo; Korean J Pathol. 1995;29(2):170-180.

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Abstract PDF: Dukes' stage of colorectal carcinoma has proven to be the most reliable and conventional prognostic indicator, followed by histological grade, lymph node metastases, tumor size, vascular and neural invasion. Flow cytometric analysis of DNA ploidy and S-phase fraciion (SPF) was examined to elucidate the correlations between sex, age, preoperative serum carcinoembryonic antigen (CEA) value, Dukes' stage, tumor site, size, gross features, histologic grade, and survival rate in 117 paraffin-embedded tissues of 68 cases of colorectal adenocarcinoma in Dukes' stage and 39 cases of colorectal adenoma and 10 cases of normal colonic mucosa. DNA aneuploidy was detected in 30 cases(44%) in adenocarcinomas and 6 cases (15%) in adenomas. Although the DNA ploidy and SPF did not show any correlation with sex, age, preoperative serum CEA level, Dukes' stage, tumor size, site and gross features, the incidence of DNA aneuploidy in the moderately differentiated adenocarcinomas was significantly higher than that of the well differentiated adenocarcinomas (p=0.0127) An apparent correlation was found between survival rate and DNA ploidy, Dukes' stage, histologic grade and preoperative serum CEA value. Dukes' stage was the most reliable prognostic indicator (p=0.0106), followed by histologic grade (p=0.0230), DNA aneuploidy (p=0.0251) and preoperative serum CEA level. (p=0.0369) In the patients with Dukes' stage C, DNA aneuploidy was more important than histologic grade as a prognostic indicator (p=0.0202). Although high SPF, greater than 21% in adenocarcinoma, was associated with the lower 5-year survival rate (12.0%), it was not statistically significant. These results suggest that DNA aneuploidy is regarded as biologic aggressiveness and considered as independent and/or dependent prognostic indicator along with Dukes' stage. However, prognostic utility of the SPF was not significant.

Primary Linitis Plastica of the Rectum: A Clinico-Pathologic Analysis of Five Cases with Special Reference to Comparison with Gastric Form.: Mee Soo Chang, Yong Il Kim, Woo Ho Kim, In Ae Park; Korean J Pathol. 1991;25(2):114-122.

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Abstract PDF: Colorectal cancer can have a gross appearance similar to linitis plastica of the stomach. However, most of these cases are not primary colorectal lesions but are, indeed, metastases from other sites. This study was designed to answer the following questions; (1) Why is the linitis plastica of the large intestine so rare compared to that of te stomach? (2) Which part of the large intestine is predominantly affected by linitis plastical form? (3) Is the histogenesis of linitis plastica involving the lagre intestine similar to that involving the stomach? Of the 911 cases of the resected colorectal primary cancer, we found only 4 cases of primary linitis plastica of the intestine (0.4%) and another one case referred from other hospital. All involved the rectum; they were of encircling carcinoma with diffuse transmural infiltration of signet ring cell carcinoma accompanied by marked desmoplasia as in the gastric form. Signet ring cell carcinoma of the large intestine comprised 1.8%(n=16) of the total colorectal cancer(n=911), and predominantly occurred in the rectum(n=8). There was no histologic difference between the linitis plastica in both stomach and colon in terms of desmoplastic reaction, once the tumor infiltrated into the submucosa. We conclude that rarity of signet ring cell carcinoma in the large intestine together with its predominant occurrence in the rectum can explain low incidence of primary colorectal linitis plastica and high preference in the rectum.

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