[AMJ 2019;12(1):34-37]

A rare clinical case of synchronous colorectal cancer, affecting the transverse

colon
Strahil Strashilov1, Angel Yordanov2
1. Department of Plastic Restorative, Reconstructive and Aesthetic Surgery, Medical University Pleven,
Bulgaria
2. Clinic of Gynecologic Oncology, Medical University Pleven, Bulgaria

CASE STUDY Implications for Practice:

1. What is known about this subject?
Please cite this paper as: Strashilov S, Yordanov A. A rare Synchronous colorectal cancer is a rare condition. Its
clinical case of synchronous colorectal cancer, affecting the incidence is about 3.5 per cent of all carcinomas that involve
transverse colon. AMJ 2019;12(1):34–37. the colon and rectum.
https://doi.org/10.21767/AMJ.2018.3552
2. What new information is offered in this case study?
The two synchronous colon carcinomas are of the same
Corresponding Author: histology but with different malignant potential.
Angel Danchev Yordanov
Clinic of Gynecologic Oncology, University Hospital “Dr. 3. What are the implications for research, policy, or
Georgi Stranski”, Medical University Pleven, Georgi Kochev practice?
8A, Bulgaria It complements the knowledge about synchronous
Email: [email protected] colorectal carcinoma.

Background
ABSTRACT
Synchronous colorectal cancer is a relatively rare condition,
which presents with the simultaneous development of more
Synchronous colorectal cancer is a rare condition, which than one primary carcinoma and affects different segments
presents with the simultaneous development of more than of the colon and rectum. Its incidence is about 3.5 per cent
1
one primary carcinoma and affects different segments of of all carcinomas that involve the colon and rectum. The
the colon and rectum. The incidence of this disease is about gender distribution of this disease in females and males is
2-6 7-11
3.5 per cent of all carcinomas of the colon and rectum and respectively 1:1.8, mean age 63. Adenocarcinoma is
more often affected men. Adenocarcinoma is the most the most common histological type for synchronous
12
common histological type for synchronous colorectal colorectal cancer.
cancer.
We present a rare clinical case of a 62-year-old woman with
We present a rare clinical case of a 62-year-old woman with synchronous colorectal carcinoma, located in the transverse
synchronous colorectal carcinoma, located in the transverse and sigmoid colon and verified histologically by
and sigmoid colon and verified histologically by colonoscopy.
colonoscopy.
Case details
Key Words We present a 62-year-old woman with comorbidities of
Colorectal cancer, synchronous colorectal cancer, colorectal arterial hypertension, chronic bronchitis and pulmonary
adenocarcinoma emphysema. She was initially admitted to the Clinic of
Gastroenterology and Hepatology in Dr. Georgi Stranski
University Hospital in Pleven, Bulgaria. The patient
presented with persistent constipation, continuing for years

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and hardly affected by laxatives, and clinical and laboratory The case was reviewed by an oncological committee. The
signs of iron-deficiency anaemia. Years before, a contrast x- treatment strategy included surgical treatment, eventually
ray examination of the colon with per rectal application of followed by adjuvant chemotherapy. After discharge from
barium sulphate has revealed elongated and twisted the Clinic of Gastroenterology, the patient was referred to
sigmoid colon. Laboratory tests after admission showed low the clinic of surgery at Dr. Georgi Stranski University
values of Hb (97g/l) and Hct (0.289), high ESR (70/95mm) Hospital. Resection of the ascending, transverse, descending
and slightly elevated CEA (7.9U/ml) and CA 19-9 (47U/ml). and sigmoid colon and the proximal third of the rectum was
Abdominal sonography revealed hepatic steatosis without performed in compliance with all rules for surgical radicality
metastases and no gallstones. There were no other (Figure 3).
pathological findings. Colonoscopy revealed two tumours in
the large intestine, almost obturating the lumen in the Figure 3: Colorectal resection with synchronous carcinoma
transverse and the sigmoid colon. Histologically, the two
samples were determined as adenocarcinomata. Tumor
locations are further confirmed by contrast axial abdominal
computed tomography – Revolution Evo GE with Omnipack
100 ml. Intravenous and Urografin oraly, which further
indicates that the carcinomas are a second radiological
stage (Figures 1 and 2).

Figure 1: Tumour of transversal colon confirmed by

abdominal CT

Bowel continuity was restored with a termino-terminal

anastomosis between the caecum and the middle third of
the rectum. The histopathological examinations with
haematoxylin-eosin indicates that the transverse colon
carcinoma was defined as a moderately differentiated
adenocarcinoma, infiltrating the intestine wall, including the
serosa, with no metastases in the removed 13 regional
lymph nodes (рТ3N0М0) and that the sigmoid colon tumour
Figure 2: Tumour of sigmoidal colon confirmed by was also moderately differentiated adenocarcinoma, non-
abdominal CT infiltrating the serosa, and with diffuse metastases in 4 out
of 7 regional lymph nodes (рТ2N2М0). After discharge, the
patient was referred to the department of oncology for
adjuvant chemotherapy with leucovorin calcium (folinic
acid), 5FU and oxaliplatin (FOLFOX).

Discussion
Synchronous colorectal cancer is relatively rare, accounting
1
for 3.5 per cent of all carcinomas of the colon and rectum.
It is more often seen in males, as compared to females
2-6
(ratio 1.8:1). The most frequently affected age group is of
7-11
individuals aged 60–65. In the case, we report the
woman was 62-years-old.

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The most common predisposing factors for the Conclusion

development of synchronous colorectal carcinoma include Synchronous colorectal carcinoma is sporadic. It usually
inflammatory diseases of the intestines, hereditary non- occurs on top of other inflammatory and genetic diseases of
polypous colorectal carcinoma, family history of the colon, and the sigmoid colon and the rectum are most
adenomatous polyposis and chronic ulcero-hemorrhagic often affected.
13-16
colitis. In this case, the most likely predisposing factor
was an inflammatory disease of the colon: the patient When treating synchronous colorectal carcinoma, mostly
reports she had had abdominal discomfort and obstipation broadened resection techniques are used.
for the last few years.
The prognosis for synchronous colorectal carcinoma is
Colorectal carcinomas usually affect the sigmoid colon and worse compared to that of solitary carcinoma.
the rectum, and there is a specific difference regarding
15
location between solitary and synchronous tumours.
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PEER REVIEW
Not commissioned. Externally peer reviewed.

CONFLICTS OF INTEREST
The authors declare that they have no competing interests.

FUNDING
This publication is supported by Project N BG05M2OP001-
2.009-0031-C01

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