|Year : 2003 | Volume
| Issue : 3 | Page : 118-119
Primary squamous cell carcinoma of caecum
S Bhat1, M Pai2, RP Premnath1
1 Department of General Surgery, Kasturba Medical College, Mangalore, India
2 Department of Pathology, Kasturba Medical College, Mangalore, India
Light House, Poly Clinic I, Basement Light House, Condomonium, Light House Hill Road, Mangalore - 575001
Source of Support: None, Conflict of Interest: None
Proximal to the anal canal, carcinomas composed in whole or in part of squamous epithelium are distinctly uncommon, accounting for 0.1 per cent of all colorectal carcinomas. Pure squamous cell carcinoma of the colorectum are extremely rare. Here we report a case of primary squamous cell carcinoma of the caecum in a 55 year old lady from South India.
Keywords: Squamous cell carcinoma, Caecum.
|How to cite this article:|
Bhat S, Pai M, Premnath R P. Primary squamous cell carcinoma of caecum. Indian J Cancer 2003;40:118-9
| » Introduction|| |
Primary squamous cell carcinoma of the colon and rectum is an exceedingly rare malignancy. Before such a condition is accepted as genuine, care must be taken to exclude metastatic tumour presenting as primary growth, most likely from the cervix.
| » Case Report|| |
A fifty five year old housewife presented to us with complaints of pain and a mass in the right iliac fossa since fifteen days. She also complained of weakness with loss of weight and appetite since the last couple of months. She had no other symptoms. There was no significant past history or family history.
On examination she was anaemic. Abdominal examination revealed a 6 x 5 cm tender firm mass in the right iliac fossa with restricted mobility. Rest of the abdomen was normal. Rectal and vaginal examinations were equivocal.
Investigations revealed a haemoglobin of 8 g%. Abdominal ultrasonography revealed thickening of the bowel in the right iliac fossa. Barium enema revealed a filling defect in the caecum as shown in [Figure - 1].
After a pre-operative evaluation the patient was taken up for an exploratory laparotomy which revealed a 6 x 6 cm growth in the caecum infiltrating the psoas muscle. A right hemicolectomy with removal of adjoining pericolic lymph nodes was carried out. An ileo-transverse anastomosis was done. The postoperative period was uneventful.
Gross examination revealed a right hemicolectomy specimen measuring 18 cm in length as shown in [Figure - 2]. At the region of the caecum there was an ulcero-proliferative tumour measuring 6 x 5 x 3 cm.
Histological study of multiple sections through the tumour as shown in [Figure - 3], showed sheets of polygonal to pleomorphic cells with abundant keratinization. The tumour cells were found to infiltrate the mucosa, submucosa and inner portions of the muscularis propria and were separated by thin fibrous septae. The two lymph nodes received with the specimen did not show any metastases.
| » Discussion|| |
By convention, tumours 7 cm proximal to the dentate line usually have been excluded from the discussion of squamous cell carcinoma of the colon.
Primary squamous cell carcinoma of caecum is relatively rare. The first report of pure squamous cell carcinoma of colon was by Schmidtman in 1919, in a 65 year old man. Comer et al in 1971 presented a series of 8 cases of squamous cell carcinoma of colon. Balsano reported two cases of squamous cell carcinoma of the caecum along with a summary of nine previous cases.
The following criteria have to be met for a diagnosis of pure squamous cell carcinoma:
(i) No evidence of primary squamous cell carcinoma exists elsewhere that could be a source of metastasis or direct extension to the bowel.
(ii) The affected segment of bowel is not in continuity with a squamous lined fistula.
(iii) No contiguity exists between the tumour and the anal squamous epithelium. Mucin should be absent, intercellular bridges should be visible and keratin may or may not be observed.
(iv) In the present case all the above criteria are satisfied.
Several pathogenic theories regarding the origin of squamous cell carcinoma colon have been proposed in literature.,
(i) Proliferation of uncommitted reserve or basal cells following mucosal injury.
(ii) Squamous metaplasia of glandular epithelium resulting from chronic irritation.
(iii) Origin from embryonal nests of ectodermal cells.
(iv) From stem cells.
The present case showed no apparent external influence (i.e. ulcerative colitis, schistosomiasis, etc.) which might have induced the squamous cell carcinoma. Review of literature data in previous reports,,, suggests a right sided predominance of squamous cell carcinoma.
The overall 5 year survival rate for these patients in the literature is 30%, which is less than 50% for those with adenocarcinoma of the colon. The present case is on the ninth month of follow-up and has not shown any evidence of recurrence.
| » References|| |
|1.||Comer TP, Beahrs O, Dockerty MD. Primary Squamous Cell Carcinoma and adenocarcinoma of colon. Cancer 1971;28:1111-7. |
|2.||Schmidtman M. Zcor Kenntis Settener Krebs-formen Virchows. Arch Path Anat 1919;226:100-18. (Cited by 1). |
|3.||Michelassi F, Mishlove LA, Stipa F, Block GE. Squamous cell carcinoma of the colon. Dis Colon Rectum 1988;31:3,228-234. |
|4.||Lundquest DE, Marcus JN, Thorson AG, Massop D. Primary Squamous cell carcinoma of the colon arising in a villous adenoma. Hum Pathol 1988;19:362-4. [PUBMED] |
|5.||Burgers PA, Lupton EW, Talbot IC. Squamous cell carcinoma of the proximal colon: Report of a case and review of the literature. Dis Colon Rectum 1979;22:241-4. |
|6.||Balsano NA. Squamous cell carcinoma of the caecum. Arch Surg 1985;120:1176-7. [PUBMED] |
|7.||Bansal M, Fenoglio CM, Robbery SJ , King DW. Are metaplasias in colorectal adenomas truly metaplasia ? Am J Pathol 1984;115:253-65. |
[Figure - 1], [Figure - 2], [Figure - 3]
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