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Colonic Mass, Colorectal Adenocarcinoma

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

Journal of Pediatric Gastroenterology and Nutrition: March 2011 - Volume 52 - Issue 3 - p 253
doi: 10.1097/MPG.0b013e3182019dc0
Image of the Month

Division of Pediatric Gastroenterology, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland.

Address correspondence and reprint requests to Joel Friedlander, DO, MBe, CDRCP, 707 SW Gaines St, Portland, OR 97239 (e-mail: friedlan@ohsu.edu).

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

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

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).

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REFERENCES

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