Signet-ring colorectal carcinoma

Abstract

Introduction. Colorectal cancer is the third most common cancer worldwide. Signet-ring carcinoma is an extremely rare subtype of colorectal cancer, with frequency ranges 0.3–4.6%. The diagnosis of this type of cancer is based on pathohistological analysis. Case outline. A 58-year-old patient was admitted due to abdominal pain and abdominal swelling. The physical findings indicated abdomen above the level of the chest, soft, painfully sensitive in the left hemiabdomen, with positive clinical signs of ascites. Laboratory analyzes indicated positive inflammatory syndrome, elevation of D-dimer and CA-19-9. Ascites analysis showed the presence of malignant cells. Computed tomography revealed hepatomegaly, liver steatosis, as well as multiple secondary deposits in the liver, ascites, and peritoneal implants. Colonoscopy showed ulceration of the right colon, which was covered with fibrin. The pathohistological findings indicated poorly differentiated, invasive adenocarcinoma of the signet ring carcinoma type. The patient was treated with analgesics, diuretics, proton pump inhibitors, beta 2 blockers, angiotensin-converting enzyme inhibitors, low-molecular-weight heparin, antibiotics, and supportive therapy. The patient was discharged after 10 days of hospitalization. He was presented to the multidisciplinary team, which decided on further symptomatic therapy. Conclusion. Signet-ring colon cancer is a rare, aggressive tumor with a poor prognosis. Although it is most often localized in the stomach, it is necessary to think about the colorectal localization of this tumor in the differential diagnosis of patients with colonic complaints, especially if they have “alarm symptoms” and if they are younger.

Keywords

• colorectal cancer
• signet-ring carcinoma
• peritoneal carcinomatosis
• ascites
• colonoscopy