Idiopathic Ileo-Ileo-Cecal Intussuception in a 25-Year-Old Female.

BACKGROUND Intussusception is defined as the penetration or telescoping of a segment of bowel into a more distal segment. Intussusception is a common cause of small bowel obstruction, especially in children. However, this finding is much less common in adults. Furthermore, when present in adults, intussusception is often found in association with some sort of organic mass, such as a tumor or pancreatic divisum that acts as a lead point, dragging the proximal segment into the distal one. The presence of an intussusception in an adult patient with no obvious lead point is very uncommon. CASE REPORT Here we report a case of ileo-ileo-cecal double intussusception in an adult patient that yielded no lead point on surgical exploration. The patient was a 25-year-old female who presented with symptoms of obstruction and was diagnosed with the intussusception via computed tomography scan. Surgical resection of the bowel was necessary as reduction could not be accomplished. CONCLUSIONS The finding of intussusception in an adult patient is far less common than in children, and even more rare when a lead point is not established. When surgery is required, a thorough exploration should be performed to search any signs of a potential lead point. Laparoscopy is usually preferred to laparotomy; however, in this case the degree of distention determined the surgical approach. Thus, due to severe distention, laparotomy was preferred.

Mixed adenoneuroendocrine carcinoma of the colon: molecular pathogenesis and treatment.

BACKGROUND/AIM: We report a case of a mixed adenoneuroendocrine carcinoma developed in a colorectal adenocarcinoma with lymph node and liver metastases exclusively emanating from the neuroendocrine carcinoma component. The patient underwent right hemicolectomy and postoperatively received chemotherapy with cisplatin and etoposide and subsequent high-dose induction chemotherapy, followed by autologous stem cell transplantation. Following this treatment, there was a complete remission. Currently, thirty months after treatment, the patient is in unmaintained complete remission. Comparative exome sequencing of germline DNA and DNA from the two separate malignant components revealed six somatic changes in cancer consensus genes. Both components shared somatic mutations in Adenomatous polyposis coli (APC), Kirsten rat sarcoma viral oncogene homolog (KRAS), B-cell CLL/lymphoma 9 (BCL9) and Forkhead Box P1 (FOXP1) genes. Mutation in SWI/SNF related, matrix associated, actin dependent regulator of chromatin, subfamily a, member 4 (SMARCA4) was only found in the neuroendocrine carcinoma component. The finding of several identical somatic mutations in both components supports a clonal relationship between the neuroendocrine carcinoma and the adenocarcinoma. We suggest that a mutation in SMARCA4 could be responsible for the transformation of the adenocarcinoma component into the neuroendocrine phenotype.

Colonic angiosarcoma: A case report and review of literature.

INTRODUCTION: Angiosarcomas are rare tumours that arise from the vascular endothelium. They can occur anywhere in the body, mostly affecting the head and neck. Their occurrence in the gastrointestinal tract is quite rare with a few reported cases in medical literature. PRESENTATION OF CASE: A 40-year-old man presented with metastatic sigmoid colon angiosarcoma, for which he was operated due to endoscopically uncontrollable massive tumour bleeding. The patient is presently still alive at 24 months after his first presentation. He is receiving palliative care. DISCUSSION: This article presents a review of the literature on this rare clinical entity, emphasising the very aggressive behaviour and the poor outcome of this malignancy. We present, briefly, 17 reported cases on primary colonic angiosarcoma since 1949. CONCLUSION: The role of chemotherapy and radiation is established neither in the adjuvant setting nor in metastatic disease. Surgery is the mainstay to treat localised colorectal angiosarcomas.