Case report: A mixed rectal tumor and adenocarcinoma

Prof. John M. Carethers reported an unusual case of a mixed rectal tumor containing a superficial tubulovillous adenoma with deeper areas of high grade malignant spindle cells and an invasive adenocarcinoma. This will be published on July 21, 2008 of the World Journal of Gastroenterology.

A 52-year-old woman presented with a rectal mass and intermittent hematochezia. Superficial biopsies during colonoscopy revealed a tubulovillous adenoma with high-grade dysplasia. Endoscopic ultrasonography confirmed an invasive nature of the mass, and deeper biopsies revealed the presence of neoplasm with mixed histological components. The surgically-excised specimen demonstrated the presence of poorly differentiated spindle cells underneath the tubulovillous adenoma with another intermediate stage: invasive adenocarcinoma. Based on the histological appearance and immunohistochemical studies, a diagnosis of sarcomatoid carcinoma was made. Only nine cases of sarcomatoid carcinomas of the colorectum have been reported to date and this is the first report of co-existence of sarcomatoid carcinoma and invasive adenocarcinoma with tubulovillous adenoma. This observation supports the "monoclonal theory" of pathogenesis with an adenoma-sarcoma progression with or without an intermediate stage of carcinoma in between.

Reference: Lee JK, Ghosh P, McWhorter V, Payne M, Olsen RK, Krinsky ML, Ramamoorthy SL, Carethers JM. Evidence for Colorectal Sarcomatoid Carcinoma Arising from Tubulovillous Adenoma. World J Gastroenterol 2008; 14(27): 4389-4394
http://www.wjgnet.com/1007-9327/14/4389.asp

Correspondence to: John M. Carethers, MD, Professor of Medicine and Chief, Division of Gastroenterology, University of California, San Diego UC 303 (MC 0063), 9500 Gilman Drive, La Jolla CA 92093-0063, United States. jcarethers@
Telephone: +1-858-5343320 Fax: +1-858-5343338

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