Rare Synchronous Alliance of Three Commonly Occurring Gastrointestinal Tumors—a Case Report and Brief Review of Literature

摘要

Introduction: Carcinoids are the second most common neoplasms of small bowel and the most common neoplasms of the appendix. They occur at a rate of 2.5/100,000 people. Most of them are detected incidentally. There are no specific clinical features, except in cases presenting with carcinoid syndrome. Therefore, a definite diagnosis is often difficult before surgery [1]. Synchronous association of gastrointestinal tract carcinoids with colonic adenocarcinoma is an infrequent but a well known occurrence [2]. Pearson and Fitzgerald first described the association of carcinoid with a synchronously occurring non-carcinoid neoplasia in 1949 [3]. It is also well established that the incidence of adenomatous polyps in patients with colorectal carcinomas is higher than in the general population. However, the coexistence of all these three tumors in a patient has been rarely reported. So uncommon is this association that we could find only a single such case in an extensive Medline search [4]. We present a case of this uncommon alliance in an elderly male, who underwent emergency laparotomy for large bowel obstruction secondary to carcinoma transverse colon. Extended right hemicolectomy with excision of regional lymph nodes and ileostomy were performed. The final histopathology revealed an adenocarcinoma of transverse colon, an adenomatous polyp in ascending colon, and a neuroendocrine carcinoma in the distal ileum.