Sporadic Mucinous Adenocarcinoma of the Colon in an Adolescent Male: A
Case Report and Review of the Literature
Abstract
Colorectal cancer (CRC) is commonly seen in adult patients but makes up
less than 1% of cancers in pediatric patients, with the largest known
pediatric study having a sample size of 81 patients taken over a span of
roughly 40 years. Patients typically present with nonspecific symptoms
such as abdominal pain, nausea, and vomiting, which can result in the
diagnosis being missed. Histopathology is typically unfavorable with
signet ring colon cancer and mucinous adenocarcinoma with signet ring
cell features being common. Treatment guidelines are based largely on
adult protocols and include surgical resection followed by chemotherapy,
with the addition of bevacizumab or cetuximab in higher-risk
populations. In our case, we present a 17-year-old male with abdominal
pain and weight loss who was found to have metastatic sporadic mucinous
adenocarcinoma with signet ring cell features. Oncotype next generation
sequencing was found to be microsatellite stable, human epithelial
growth factor receptor 2 negative, Kristen rat sarcoma viral oncogene
homolog/v-raf murine sarcoma viral oncogene homolog B1/neuroblastoma
reticular activating system wild type, and low tumor mutation burden
with 3.7 mutations per megabase. He was treated with FOLFIRINOX at 70%
dosing without bevacizumab due to recurrent admissions for small bowel
obstructions and surgeries. Unfortunately, his cancer did not respond,
so he proceeded with palliative chemotherapy. He expired 12 months
later. This case raises the need for research on the biology of CRC in
pediatric patients as it is different from adults. It also underlines
the necessity of the development of guidelines on CRC treatment in
pediatric patients by initiating pediatric clinical trials or lowering
the age of adult trials to less than 18 years of age.