|Year : 2015 | Volume
| Issue : 3 | Page : 82-84
Primary squamous cell carcinoma of the transverse colon: Report of a case
Wael Al-Shelfa1, Mahmoud Al-Sadik2, Ehab Al-Nakoury3, Ahmad Hashim4, Amal Farid5
1 Department of Surgery, Zagazig University, Zagazig, Egypt
2 Department of Surgery, Saudi-German Hospital, Jeddah, Saudi Arabia
3 Medical Oncology Department, Cairo University, Cairo, Egypt
4 Gastro-interology Department, Cairo University, Cairo, Egypt
5 Pathology Department, Almonofia University, Almonofia, Egypt
|Date of Web Publication||14-Mar-2016|
Dr. Wael Al-Shelfa
Ass. Professor of Surgery, Zagazig University, Zagazig
Source of Support: None, Conflict of Interest: None
It is very rare that squamous cell carcinoma (SCC) arises from colorectal epithelium. A 34-year-old Filipino man was treated with chief complaints of anorexia, abdominal pain, and vomiting. The histological diagnosis as SCC was determined by biopsy during a colonoscopy. We diagnosed primary SCC of the colon after exclusion of any malignant lesions found by systemic computed tomography. Surgical complete resection was performed. The prognosis of this disease seems to be worse than that of adenocarcinoma.
Keywords: Colonoscopy, prognosis, squamous
|How to cite this article:|
Al-Shelfa W, Al-Sadik M, Al-Nakoury E, Hashim A, Farid A. Primary squamous cell carcinoma of the transverse colon: Report of a case. Saudi Surg J 2015;3:82-4
|How to cite this URL:|
Al-Shelfa W, Al-Sadik M, Al-Nakoury E, Hashim A, Farid A. Primary squamous cell carcinoma of the transverse colon: Report of a case. Saudi Surg J [serial online] 2015 [cited 2022 Aug 16];3:82-4. Available from: https://www.saudisurgj.org/text.asp?2015/3/3/82/178680
| Introduction|| |
The first case of squamous cell carcinoma (SCC) of the colon was reported in 1919.  It is well known that more than 90% of colorectal diseases are adenocarcinoma, with the majority of remaining cases having no epithelial histology such as carcinoid tumors, sarcomas, and lymphoid tumors.  The incidence of SCC of the colon and rectum has been reported to be 0.25-0.1/1000 colorectal carcinomas.  Clinical characteristics, biologic behavior, and treatment response of this colorectal cancer are largely unknown. In this paper, we report a case of primary SCC of the transverse colon with malignant fistula to the stomach.
| Case Report|| |
A 34-year-old man underwent a surgical operation for transverse colon cancer in 2014. Histological feature was moderately differentiated SCC. He was presented to Saudi-german Hospital, Jeddah, with anorexia, abdominal pain, and vomiting. Abdominal examination revealed a mass in the upper abdomen. A colonoscopy revealed stenosis with ulceration and a biopsy was taken from a mass present in the transverse colon; a histopathological examination proves this mass to be SCC. Abdominal computed tomography (CT) showed wall thickness and stenosis of the transverse colon and lymph node enlargement around the tumor [Figure 1]. Chest, neck, and cervical CT were done; tumors were only identified in the colon. Therefore, we concluded that the colon was the primary lesion site. Intraoperatively, this tumor was a huge mass which penetrated the stomach and adhered to the mesentery of the small bowel, partial resection of the stomach was performed. The resected mass was huge, 8.0 cm × 12.0 cm, with penetration to the greater curvature of the stomach [Figure 2]. Pathology demonstrated SCC of the colon invading the stomach [Figure 3]. Adjuvant chemotherapy was not started because the patient travels to his country.
|Figure 1: Abdominal computed tomography scan showed a large heterogeneous mass involving the colon at the transvers colon and swelling lymph nodes|
Click here to view
|Figure 2: Macroscopic appearance. The resected specimen was a huge mass of 8.0 cm × 12.0 cm penetrating the stomach|
Click here to view
|Figure 3: Histopathological examination demonstrating moderately differentiated squamous cell carcinoma (H and E, ×40)|
Click here to view
| Discussion|| |
SCCs of the colon are an extremely rare clinical entity. The first case of a pure SCC of the colon was reported in the German literature by Schmidtmann in 1919.  Chronic inflammation (inflammatory bowel disease, human papillomavirus, amebiasis, and schistosomiasis), and neoplasm in an adjacent organ (ovary, endometrium, and prostate) have been reported to be associated with some colonic SCCs. 
Certain criteria must be satisfied before a diagnosis of primary SCC of the colon is made.  First, metastasis from other sites to the bowel must be ruled out. Second, a squamous-lined fistulous tract must not involve the affected bowel, because this may be a source of SCCs. Third, SCCs of the anus with proximal extension must be excluded. Fourth, SCC must be confirmed by histological analysis. Our case satisfied all these criteria.
In 1971 Comer et al.  suggested a poorer prognosis for patients with colorectal SCC than adenocarcinoma. However, the prognosis of patients with colorectal SCC is difficult to establish because of the rarity of these tumors. The colorectal SCC seems to be more frequently locally invasive and more likely to involve regional lymphatics than the adenocarcinomas, probably because of a delayed diagnosis. In this case, the tumor was T4 (invasion of the stomach, and mesentery of small bowel).
The role of adjuvant chemotherapy or radiation remains unknown. Gelas et al.  reported that surgical resection after a neoadjuvant combination of chemotherapy and external beam radiation therapy was useful for rectal SCC. Juturi et al.  reported that combination of cisplatin, 5-fluorouracil, and leucovorin would be a possible treatment option for patients with metastatic colorectal SCC. Copur et al.  reported that cisplatin, etoposide, and 5-fluorouracil combination chemotherapy was effective and serum SCC antigen level was a useful marker of response to chemotherapy. Chemotherapy for colorectal SCC has been controversial. Nowadays, we think that surgical resection may be the first choice, and adjuvant treatment (chemotherapy or radiation therapy) may be done if the patient has a good performance status.
| Conclusion|| |
Advanced colorectal SCC with invasion to adjacent organs and metastatic lymph nodes had a poor prognosis. Treatment selection is difficult because colorectal SCC is a very rare disease. However, surgical resection and adjuvant chemotherapy are a better approach to the treatment of colorectal SCC.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Schmidtmann M. Zur kenntnis seltener krebsformen. Virchows Arch Pathol 1919;226:100-18.
Morson BC, Sobin LH. Histologic Typing of Intestinal Tumors: WHO Technical Report 15. Geneva: World Health Organization; 1976.
Gelas T, Peyrat P, Francois Y, Gerard JP, Baulieux J, Gilly FN, et al.
Primary squamous-cell carcinoma of the rectum: Report of six cases and review of the literature. Dis Colon Rectum 2002;45:1535-40.
Frizelle FA, Hobday KS, Batts KP, Nelson H. Adenosquamous and squamous carcinoma of the colon and upper rectum: A clinical and histopathologic study. Dis Colon Rectum 2001;44:341-6.
Williams GT, Blackshaw AJ, Morson BC. Squamous carcinoma of the colorectum and its genesis. J Pathol 1979;129:139-47.
Comer TP, Beahrs OH, Dockerty MB. Primary squamous cell carcinoma and adenoacanthoma of the colon. Cancer 1971;58:111-7.
Juturi JV, Francis B, Koontz PW, Wilkes JD. Squamous-cell carcinoma of the colon responsive to combination chemotherapy: Report of two cases and review of the literature. Dis Colon Rectum 1999;42:102-9.
Copur S, Ledakis P, Novinski D, Mleczko KL, Frankforter S, Bolton M, et al.
Squamous cell carcinoma of the colon with an elevated serum squamous cell carcinoma antigen responding to combination chemotherapy. Clin Colorectal Cancer 2001;1:55-8.
[Figure 1], [Figure 2], [Figure 3]