East Carolina University/Vidant Medical Center Greenville, NC
Gbeminiyi Samuel, MD, MSPH1, MaryKate Kratzer, MD1, Philip Twene, MD, MPH2, Mohammed Salah Ali Hussein, MD3, Muhammad Ali4, Deepak Donthi, MD5, Abdullah Thayyil, MD6, Eslam O. Ali, MD6; 1East Carolina University/Vidant Medical Center, Greenville, NC; 2Howard University Hospital, Washington, DC; 3Al Azhar University, Cairo, Al Qahirah, Egypt; 4Oakwood School, Greenville, NC; 5East Carolina University, Greenville, NC; 6Vidant Medical Center, Greenville, NC
Introduction: Amphicrine tumors are a rare subset of mixed adenoneuroendocrine carcinomas (MANEC) which are made up of at least 30% neuroendocrine cells and 30% exocrine cells. Amphicrine carcinomas are unique in that each individual tumor cell contains both neuroendocrine and exocrine properties. MANECs are rarely found in the gastrointestinal tract, and are especially uncommon in the colon.
Methods: A 67-year-old Caucasian female with past medical history of diabetes, diverticulosis, COPD, obstructive sleep apnea and colonic polyps presented with one week of generalized abdominal pain, non-bilious emesis, and diarrhea. Prior to symptom onset, she was taking polyethylene glycol as needed for constipation. Patient denied any family history of cancer and reported a 30 pack year smoking history. Physical exam was significant for generalized abdominal tenderness. Labs revealed microcytic anemia, mild elevation of serum creatinine, and elevated Carcino-Embryonic Antigen (CEA) at 6.6. A Computed Tomography (CT) scan of the abdomen showed segmental pericolonic fat stranding and hyperemia of the cecal wall. Diagnostic colonoscopy revealed a fungating, non-bleeding, partially obstructing mass in the proximal ascending colon (Figure 1). Biopsies showed intramucosal adenocarcinoma. Given no evidence of distant metastasis on CT of the chest or abdomen/pelvis, laparoscopic exploration was performed to evaluate for overt carcinomatosis. Patient ultimately underwent a robotic-assisted right hemicolectomy with intracorporeal ileocolic anastomosis and full omentectomy. The tumor grossly consisted of a large circumferential ulcerated and necrotic tumor situated in the ascending colon 3.5 cm distal to the ileocecal valve, measuring 7.0 cm in circumference and 4.0 cm in width. Histologic examination showed moderately differentiated glands with some containing mucin globules (Figure 2) invading through the muscularis propria into the pericolonic fat. Immunohistochemical stains for synaptophysin (Figure 3) and CD56 were positive, confirming neuroendocrine origin. Mucicarmine stain was positive in 70-80% of the tumor cells, and Ki-67 index was 20%. The final diagnosis was MANEC. Discussion: Two months post-operatively, PET scan was negative for any overt metastatic disease or re-demonstration of significant uptake. Patient is currently tolerating fluorouracil-based chemotherapy. This case is evidence of the complexity of amphicrine tumors, and the multidisciplinary approach necessary for successful management.
Fungating, nonbleeding, partially obstructing mass in proximal ascending colon
Moderately differentiated glands with some containing mucin globules
Immunohistochemical stain for synaptophysin
Disclosures: Gbeminiyi Samuel indicated no relevant financial relationships. MaryKate Kratzer indicated no relevant financial relationships. Philip Twene indicated no relevant financial relationships. Mohammed Salah Ali Hussein indicated no relevant financial relationships. Muhammad Ali indicated no relevant financial relationships. Deepak Donthi indicated no relevant financial relationships. Abdullah Thayyil indicated no relevant financial relationships. Eslam Ali indicated no relevant financial relationships.