Surgical Management of Peritoneal Carcinomatosis from Colorectal Primary Signet Ring Cell Carcinoma
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DO
Format
Presentation
Start Date
6-11-2020 1:30 PM
End Date
6-11-2020 1:45 PM
Abstract
Intro: Primary signet ring cell carcinomas are mainly located in stomach, but can be found in gallbladder, bladder, breast and pancreas. Primary signet ring cell carcinoma of the colon and rectum (PSRCCR) is a rare entity, accounting for 0.1%-2.6% of all colorectal cancer cases. Typically found in younger adults, it has a poor prognosis. Mean survival at diagnosis is between 20-45 months. Case Description: 21-year old Hispanic male with no significant past medical history presented with 2-week history of abdominal pain, distention, hematochezia and rapid weight loss. He was anemic and CT scan of Abdomen/Pelvis was concerning for malignancy involving the transverse colon with omental implants. Colonoscopic biopsy revealed signet ring cell adenocarcinoma, positive for CEA and pankreatin. After preoperative staging, exploratory laparotomy with cytoreductive surgery consisting of subtotal colectomy, partial gastrectomy, omentectomy, peritonectomy, and ileostomy was performed. Peritoneal cancer index was 30. Pathology revealed TP53 positivity.He recovered uneventfully and was started on NCCN recommended protocol of chemotherapy. Discussion: Peritoneal carcinomatosis is associated with poor prognosis. Such an aggressive and advanced disease is often associated with a dismal OS of 3 to 6 months without surgery. Currently, 11 months post-surgery, our patient has recovered well and has been undergoing adjuvant chemotherapy without signs of recurrence. He has had a few episodes of small bowel obstruction. As these episodes have persisted, we are planning to perform an exploratory laparotomy and possible ileostomy take down. If unexpected peritoneal disease is noted, a repeat cytoreduction (with or without HIPEC) would be recommended.
Surgical Management of Peritoneal Carcinomatosis from Colorectal Primary Signet Ring Cell Carcinoma
Intro: Primary signet ring cell carcinomas are mainly located in stomach, but can be found in gallbladder, bladder, breast and pancreas. Primary signet ring cell carcinoma of the colon and rectum (PSRCCR) is a rare entity, accounting for 0.1%-2.6% of all colorectal cancer cases. Typically found in younger adults, it has a poor prognosis. Mean survival at diagnosis is between 20-45 months. Case Description: 21-year old Hispanic male with no significant past medical history presented with 2-week history of abdominal pain, distention, hematochezia and rapid weight loss. He was anemic and CT scan of Abdomen/Pelvis was concerning for malignancy involving the transverse colon with omental implants. Colonoscopic biopsy revealed signet ring cell adenocarcinoma, positive for CEA and pankreatin. After preoperative staging, exploratory laparotomy with cytoreductive surgery consisting of subtotal colectomy, partial gastrectomy, omentectomy, peritonectomy, and ileostomy was performed. Peritoneal cancer index was 30. Pathology revealed TP53 positivity.He recovered uneventfully and was started on NCCN recommended protocol of chemotherapy. Discussion: Peritoneal carcinomatosis is associated with poor prognosis. Such an aggressive and advanced disease is often associated with a dismal OS of 3 to 6 months without surgery. Currently, 11 months post-surgery, our patient has recovered well and has been undergoing adjuvant chemotherapy without signs of recurrence. He has had a few episodes of small bowel obstruction. As these episodes have persisted, we are planning to perform an exploratory laparotomy and possible ileostomy take down. If unexpected peritoneal disease is noted, a repeat cytoreduction (with or without HIPEC) would be recommended.