Case Report
Primary small cell carcinoma of the cecum

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Abstract

Cecal extrapulmonary small cell carcinoma (cESC) is extremely rare, with only single previous report of occurrence in a child. We report a 76-year-old man admitted for evaluation of a cecal mass seen in colonoscopy. Histology revealed small cell carcinoma with classic immunohistochemical profile similar to those seen in the colon. Further clinical survey documented absence of any other masses or abnormality. To the best of our knowledge, this is the first case of primary cESC occurring in an adult. Awareness of the pathologist and clinician of the cecum as a potential site of cESC may help to prevent misdiagnosis as poorly differentiated adenocarcinoma. This is crucial because extrapulmonary small cell carcinomas usually have worse prognosis.

Introduction

Extrapulmonary small cell carcinomas (ESCs) are uncommon neoplasms when compared with those of pulmonary origin. Extrapulmonary small cell carcinoma has been described in different sites and usually in adults. To the best of our knowledge, cecal extrapulmonary small cell carcinoma (cESC) has been only reported once in a child in a setting of common variable immunodeficiency.

Section snippets

Case report

A 76-year-old man presented with an episode of rectal bleeding and change in bowel movement of insidious onset and progressive course. Past medical history was insignificant except for recurrent multifocal basal cell carcinoma in the face, which was treated initially by surgery and, on the recurrence, by radiotherapy. Physical examination was unremarkable and documented the absence of masses and lymphadenopathy. Because of the persistent complaints, sigmoidoscopy was performed and revealed a

Pathological findings

Macroscopic examination of the right hemicolectomy specimen revealed an elevated, focally ulcerated, tan, firm nodular mass that measured 3.0 × 2.0 × 0.6 cm, localized to the cecum. Examination of the remaining ascending colon revealed few polyps varying in size from 2 to 4 mm in maximum dimension.

Histological examination of the cecal tumor revealed a superficial component with feature of tubulovillous adenoma, whereas the underlying bulk of the tumor was characterized by an invasive high-grade

Discussion

The incidence of ESC compared with that of pulmonary small cell carcinoma (PSC) is very low, accounting for approximately 2.5% to 4% of the former [1], [2]. Pulmonary small cell carcinoma represents approximately 20% to 25% of all bronchogenic carcinomas [3]. In a series of 24 cases of ESC reviewed, the commonest site of ESC was the uterine cervix [4]. Primary ESC has been described in different organs, including pleura [5], thymus [1], [6], kidney [7], [8], bladder [1], prostate [9],

Conclusion

We report a case of primary ESC of the cecum occurring in a healthy adult, which, to our knowledge, is the first of its kind in an adult. Awareness of occurrence of ESC in the cecum should be highlighted because of the difference in prognosis in comparison with cecal adenocarcinoma. Strict criteria for diagnosis of ESC should be fulfilled and backed up by immunohistochemistry to avoid the overlap with poorly differentiated adenocarcinoma.

References (40)

  • L.C. Morgan

    Lung cancer in New South Wales: current trends and the influence of age and sex

    Med J Aust

    (2000)
  • J.H. Kim

    Extra pulmonary small-cell carcinoma: a single-institution experience

    Jpn J Clin Oncol

    (2004)
  • D.P. Bouvier et al.

    Small cell carcinoma of the pleura

    South Med J

    (1989)
  • E. Galanis

    Extra pulmonary small cell carcinoma

    Cancer

    (1997)
  • N.S. Majhail

    Therapy and outcome of small cell carcinoma of the kidney: report of two cases and a systematic review of the literature

    Cancer

    (2003)
  • N.P. Caraway

    Metastatic small-cell carcinoma of the prostate diagnosed by fine-needle aspiration biopsy

    Diagn Cytopathol

    (1998)
  • A.J. Sykes

    Small cell carcinoma of the uterine cervix: a clinicopathological review

    Int J Oncol

    (1999)
  • T. Noguchi

    Small cell carcinoma of the esophagus; clinicopathological and immunohistochemical analysis of six cases

    Dis Esophagus

    (2003)
  • H. Kuwabara et al.

    Small cell carcinoma of the gall bladder with intestinal metaplastic epithelium

    Pathol Int

    (1998)
  • S.C. Remick

    Extrapulmonary small-cell carcinoma. A review of the literature with emphasis on therapy and outcome

    Medicine (Baltimore)

    (1987)

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