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A Case Illustrating Challenges: Early-Onset Signet Ring Cell Rectal Carcinoma With Fulminant Peritoneal Progression
Shivraj Sharma1, Madhav Raj Karki1, Aron Neupane1
1Department of Surgical Oncology Birat Medical College Teaching Hospital Morang Nepal.
Clinical Case Reports
|April 22, 2026
Summary
Rectal signet ring cell carcinoma (SRCC) in young patients is aggressive and challenging to treat. This case shows rapid progression despite neoadjuvant chemoradiotherapy, highlighting diagnostic and therapeutic limitations.
Area of Science:
- Oncology
- Gastroenterology
- Pathology
Background:
- Signet ring cell carcinoma (SRCC) of the rectum is a rare histologic subtype.
- SRCC is often associated with aggressive behavior and poor outcomes, especially in young patients.
Purpose of the Study:
- To report a case of early-onset rectal SRCC in a young male.
- To highlight the challenges in diagnosis, staging, and treatment of this rare condition.
Main Methods:
- Case report of a 19-year-old male with rectal SRCC.
- Initial presentation with acute intestinal obstruction.
- Treatment included diversion colostomy, neoadjuvant chemoradiotherapy (nCRT).
Main Results:
- Radiologic staging (cT2N1bM0) underestimated disease extent.
- Patient developed extensive peritoneal disease post-nCRT.
- Diffuse peritoneal carcinomatosis was found during exploratory surgery, precluding further treatment.
Conclusions:
- Early-onset rectal SRCC presents significant clinical challenges.
- Conventional radiology has limitations in staging rectal SRCC.
- Aggressive clinical course and treatment limitations underscore the need for improved management strategies.
