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

Adarsh Pratap Singh, Amit Kumar, Anita Dhar, Shipra Agarwal and Sudhir Bhimaniya

Department of Surgery, AIIMS, New Delhi, India
Department of Surgery, New Delhi, India
Department of Pathology, AIIMS, New Delhi, India
Department of Cardiovascular Radiology, AIIMS, New Delhi, India

^*Correspondance to: Amit Kumar 

 PDF  Full Text DOI: 10.25107/2474-1647.2144

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 unrespectable 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

Cite the article

Singh AP, Kumar A, Dhar A, Agarwal S, Bhimaniya S. Advanced Colorectal Carcinoma with Testicular Metastasis in an Adolescent: A Case Report. Clin Surg. 2018; 3: 2144.