Signet ring cell carcinoma of colonic origin in a 13-year-old child from remote setting: a case report

Signet ring cell carcinoma (SRCC) is a distinct and aggressive subtype of adenocarcinoma that can arise throughout the tubular gastrointestinal tract, with particularly rare occurrence in the colon, especially in the pediatric population.

A 13-year-old girl from the Amhara region of Ethiopia presented with a long standing history of intermittent, crampy abdominal pain, accompanied by loss of appetite, unquantified weight loss, and easy fatigability. Two months prior to admission, her symptoms worsened, and over the course of two days, the pain became persistent and was accompanied by frequent bilious vomiting and failure to pass feces and flatus. On physical examination the patient was restless, tachycardic and in pain. Her abdomen was grossly distended and tympanic on percussion. DRE revealed an empty rectum. With the presumptive diagnosis of ileocolic intussusception the patient underwent further investigations. CBC revealed WBC count of 12,100/µL with neutrophil predominance (76%), hemoglobin 14.2 g/dl, and a platelet count of 442 × 10³/µL. An erect abdominal X-ray showed centrally located dilated bowl loops with multiple air-fluid levels. Abdominal ultrasound revealed a concentric bowel wall thickening involving the cecum and ascending colon, measuring approximately 12 mm in thickness, along with multiple adjacent enlarged paracolic and mesenteric lymph nodes. After preoperative optimization, administration of prophylactic antibiotics, and obtaining informed consent, the patient underwent exploratory laparotomy. Intraoperatively, a circumferentially thickened cecal mass causing luminal obstruction was identified, with marked proximal small bowel dilatation and multiple mesenteric lymphadenopathies.

Colorectal cancer accounts for approximately 10% of all cancer cases worldwide and remains a leading cause of cancer-related mortality. SRCC of the colon is a rare and aggressive histological subtype characterized by poor prognosis and distinct biological behavior.

Colorectal carcinoma in pediatric age group, although rare, may present with nonspecific and atypical symptoms, leading to delayed diagnosis. Therefore, colonic malignancy should be considered in the differential diagnosis of children presenting with chronic, unexplained abdominal pain and bowel obstruction symptoms, as early detection and management of the disease have a pivotal role in the prognosis.