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Colonic Mass, Colorectal Adenocarcinoma

Zhang, Zili; Friedlander, Joel; Eroglu, Yasemen; Zigman, Andrew; Moore, Franklin; Lamkin, Thomas

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Journal of Pediatric Gastroenterology and Nutrition: March 2011 - Volume 52 - Issue 3 - p 253
doi: 10.1097/MPG.0b013e3182019dc0
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A 14-year-old girl, with a history of stage 3 Wilms tumor was treated at 1 year of age with chemotherapy and flank radiation. Ten years later, she developed radiation-induced chest-wall osteosarcoma. Recent computer tomography surveillance found multiple hypodense hepatic lesions. Subsequent excision biopsy of a liver nodule demonstrated adenocarcinoma without clear origin. This finding prompted referral for endoscopy. Colonoscopy revealed 2 friable broad-based, polypoid masses partially obstructing the rectal sigmoid junction (Fig. 1A). The pathology was consistent with invasive adenocarcinoma arising in tubular adenomas (Fig. 1B, low power; C, high power). In addition, the patient had a 2-cm flat adenoma in the ascending colon, and histology confirmed tubular adenoma with high-grade dysplasia. Patient responded to chemotherapy with leucovorin, fluorouracil, oxaliplatin, and bevacizumab and awaits surgical resection.

FIGURE 1
FIGURE 1:
Colonoscopy revealed 2 friable broad-based, polypoid masses partially obstructing the rectal sigmoid junction (A). The pathology was consistent with invasive adenocarcinoma arising in tubular adenomas (B, C).

This case once again alerts pediatric gastroenterologists that colorectal cancer can occur in children under unique circumstances (1). Currently, the etiology of the multiple malignancies is unclear. The literature demonstrates that there is an association between Wilms tumor and subsequent colonic adenocarcinomas (2–4). It is conceivable that previous chemoradiotherapy could also contribute to the development of her colorectal cancer. Microsatellite instability testing is planned to test other genetic susceptibilities (5,6).

REFERENCES

1. Kudo S, Tamura S, Nakajima T, et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44:8–14.
2. Tsunematsu Y, Yoshizawa Y, Miyauchi J, et al. A novel case of Wilms’ tumor followed by colon cancer, both showing microsatellite instability. Oncology 2000;58:159–60.
3. Breslow NE, Takashima JR, Whitton JA, et al. Second malignant neoplasms following treatment for Wilm's tumor: a report from the National Wilms’ Tumor Study Group. J Clin Oncol 1995;13:1851–9.
4. Breslow NE, Lange JM, Friedman DL, et al. Secondary malignant neoplasms after Wilms tumor: an international collaborative study. Int J Cancer 2010;127:657–66.
5. Boland CR, Goel A. Microsatellite instability in colorectal cancer. Gastroenterology 2010;138:2073–87.
6. Vilar E, Gruber SB. Microsatellite instability in colorectal cancer: the stable evidence. Nat Rev Clin Oncol 2010;7:153–62.
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