Primary Squamous Cell Carcinoma of the Cecum: A Case Report

Primary squamous cell carcinoma (SCC) of the colon is an exceptionally rare diagnosis. The etiology and pathogenesis of this entity remain unclear. It usually presents in patients as an emergency, typically with the tumor in the advanced stage. We report a case of SCC of the cecum presenting with perforation, initially diagnosed as SCC of unknown origin. The patient underwent a limited right hemicolectomy and end ileostomy outside our center. The patient was referred to us for further workup and possible adjuvant chemotherapy. She was assessed clinically and found to have had poor appetite and anorexia for a month, with an intermittent fever documented at 39 degrees. Thus, the patient was elected to get admitted for a septic workup and re-staging by CT scan and tumor biomarkers. CT showed a phlegmon and abscess formation at the right iliac fossa that was attached to surrounding structures, including the abdominal wall. Drain placement at the site of the phlegmon was attempted but failed due to bowel overlapping. Therefore, the patient was booked for surgical exploration and drainage, where all structures were resected en bloc. Histopathological examination revealed well-differentiated keratinized SCC with lymph node metastasis. The diagnosis of primary SCC of the cecum was confirmed after investigations to rule out primary sources were negative. Surgical resection remains the mainstay of management, with a possible role for chemotherapy and radiation therapy. The prognosis in these cases is usually poor. This warrants early diagnosis and management. Studies are needed to establish a management protocol for this entity.