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Rectal mixed adenoneuroendocrine carcinoma: Case report
Diogo J Silva1, Joana Dos Santos2, Ana Paula Vaz3
1Medical Oncology Department, Local Health Unity Matosinhos - Hospital Pedro Hispano, Porto, Portugal.
Medicine
|October 8, 2021
Summary
Management of rare colorectal mixed neuroendocrine-nonneuroendocrine carcinomas is challenging due to limited evidence. Tailoring diagnosis and treatment to individual patient features is crucial for optimal outcomes in these complex gastrointestinal tumors.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Colorectal mixed neuroendocrine-nonneuroendocrine neoplasms (mNETs) are rare tumors with both neuroendocrine and nonneuroendocrine components.
- Underestimated incidence and conflicting data arise from non-specific macroscopic features, diagnostic challenges, and limited awareness.
- Current diagnostic and therapeutic strategies rely on guidelines for pure colorectal neuroendocrine carcinomas or adenocarcinomas due to a lack of specific trials.
Observation:
- A 76-year-old male presented with a positive fecal occult blood test during colorectal cancer screening.
- Colonoscopy revealed a rectal lesion, with biopsy confirming moderate rectal adenocarcinoma (cT2N0M0).
Findings:
- The patient underwent anterior resection, radiotherapy, and adjuvant chemotherapy (capecitabine plus oxaliplatin).
- Treatment was complicated by chronic nodular pulmonary aspergillosis and chemotherapy-induced immunosuppression, requiring voriconazole.
- Overall survival was 15 months post-progression on first-line and palliative chemotherapy (platinum plus etoposide).
Implications:
- This case highlights the difficulties in managing mNETs owing to the absence of validated guidelines and robust scientific evidence.
- Individualized approaches to diagnosis, staging, and treatment are essential for patients with these heterogeneous tumors.
- Further research is needed to establish specific diagnostic criteria and therapeutic protocols for colorectal mNETs.
