Advanced Colorectal Carcinoma with Testicular Metastasis in an Adolescent: A Case Report

Case Report

Austin J Clin Case Rep.2018; 5(2): 1134.

Advanced Colorectal Carcinoma with Testicular Metastasis in an Adolescent: A Case Report

Singh AP¹, Kumar A²*, Dhar A³, Agarwal S4 and Bhimaniya S5

¹Junior Resident, Department of Surgery, AIIMS, New Delhi, India

²Senior Resident, Department of Surgery, AIIMS, New Delhi, India

³Professor, Department of Surgery, New Delhi, India

4Assistant Professor, Department of Pathology, AIIMS, New Delhi, India

5Senior Resident, Department of Cardiovascular Radiology, AIIMS, New Delhi, India

*Corresponding author: Amit Kumar, Senior Resident, Department of Surgery, AIIMS, New Delhi, India

Received: September 02, 2018; Accepted: September 27, 2018; Published: October 04, 2018

Abstract

Introduction: Colorectal carcinoma in pediatric age group is rare and tends to be very aggressive and present late, due to which it has a very poor prognosis. It may present itself with distant metastasis. But metastasis to the testes is very rare and signifies an advanced stage of the disease. Surgery is the only effective modality to cure patients with localized colorectal carcinomas. However statistics show a higher incidence of unresectable disease and a higher metastasis rate in childhood colorectal carcinomas. We are presenting a case of advanced colorectal carcinoma in an adolescent with testicular metastasis.

Case Presentation: A 15 year old Indian male presented to surgical emergency with signs and symptoms of intestinal obstruction. He also had a history of passing blood and mucus per rectum. On examination he was having abdominal distension. On digital rectal examination, a circumferential proliferative growth was felt 1cm above the anal verge. On scrotal examination, a small nodule was felt in the right testes. In view of intestinal obstruction, the patient was taken into the emergency operation theatre and a diverting loop sigmoid colostomy was performed to relieve the obstruction. Punch biopsy from ano-rectal growth taken which suggested signet ring cell adenocarcinoma. CECT chest, abdomen and pelvis showed advanced colorectal carcinoma with distant metastasis. Ultrasonography of testes showed a hypoechoic nodule in the right testis from which a needle aspiration biopsy was done which revealed metastatic adenocarcnoma.

Conclusion: Childhood colorectal carcinomas have very poor prognosis due to their aggressive nature and late presentation. In spite of all the advances in diagnosis and treatments, the overall long term survival is still dismal in these patients. Due to rarity of this disease, screening is not recommended for individuals under the age of 50. Thus, to improve outcome, early diagnosis and treatment is paramount. For that to happen, awareness needs to be created regarding pediatric colorectal carcinoma and its signs and symptoms.

Keywords: Adolescent; Colorectal carcinoma; Testicular metastasis; Intestinal obstruction; Signet ring cell adenocarcinoma; Poor prognosis

Introduction

Colorectal carcinoma is the second most common alimentary tract carcinoma after liver tumors in children with an incidence of 1.3- 2 cases per million population, mostly present in the second decade of life [1-4]. It tends to be very aggressive and present late, due to which it has very poor prognosis. It may present itself with distant metastasis. But metastasis to the testes is very rare and signifies advanced stage of the disease. Surgery is the only effective modality to cure patients with localized colorectal carcinomas. We are presenting a case of advanced colorectal carcinoma in an adolescent with testicular metastasis.

Case Presentation

A 15 years old Indian male presented to Surgical emergency with complaints of difficulty in passing stool for one month, passage of blood and mucus per rectum for 15 days, abdominal distension for 1week and obstipation for 3 days. These symptoms were associated with significant appetite and weight loss but there was no history of fever, jaundice, malena, hemetemesis, hemoptysis, cough, chest pain, shortness of breath. There was no history of similar illness in family, and any other malignancy.

On examination patient was conscious with thin built and pallor was present. Abdomen was distended with no local bulge. On digital rectal examination, a circumferential proliferative growth was felt 1cm above the anal verge, which was occluding the lumen near completely. On scrotal examination, a small nodule was felt in Right testis. Rest systemic examination was normal.

An abdominal and chest X-ray was done as preliminary investigations which revealed signs of intestinal obstruction (Figure 1).