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Spontaneous Regression Of Transverse Colon Cancer: A Case Report.

Chida et al., 2017Colorectal cancer

Chida, K., Nakanishi, K., Shomura, H., Homma, S., Hattori, A., Kazui, K., & Taketomi, A. (2017). spontaneous regression of transverse colon cancer: a case report. Surgical case reports, 3(1), 65. https://doi.org/10.1186/s40792-017-0341-z

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Abstract

Spontaneous regression (SR) of many malignant tumors has been well documented, with an approximate incidence of one per 60,000-100,000 cancer patients. However, SR of colorectal cancer (CRC) is very rare, accounting for less than 2% of such cases. We report a case of SR of transverse colon cancer in an 80-year-old man undergoing outpatient follow-up after surgical treatment of early gastric cancer. Colonoscopy (CS) revealed a Borrmann type II tumor in the transverse colon measuring 30 × 30 mm. Because the patient underwent anticoagulant therapy, we did not perform a biopsy at that time. A second CS was performed 1 week after the initial examination and revealed tumor shrinkage to a diameter of 20 mm and a shift to the Borrmann type III morphology. Biopsy revealed a poorly differentiated adenocarcinoma. One week after the second CS, we performed a partial resection of the transverse colon and D2 lymph node dissection. Histopathology revealed inflammatory cell infiltration and fibrosis from the submucosal to muscularis propria layers in the absence of cancer cells, leading to pathological staging of pStage 0 (T0N0). The patient had an uneventful recovery, and CS performed at 5 months postoperatively revealed the absence of a tumor in the colon and rectum. The patient continues to be followed up as an outpatient at 12 months postoperatively, and no recurrence has been observed.

Case Details

Disease Location

Transverse colon

Personal Characteristics

80-year old man with previous history of pneumonia, paroxysmal atrial fibrillation and hypertension; received surgery for early gastric therapy

Clinical Characteristics

Lab evaluation during third year following gastrectomy showed an elevated level of tumour marker carbohydrate antigen and colonoscopy showed borrmann type ii tumour, stage i, in transverse colon measuring 30x30mm, CT scan showed increased wall thickness in left half of transverse colon and absence of increased CT values in surrounding fatty area suggested that invasion depatienth of tumour was muscularis propria; CT 1 week after presentation showed shrinkage in tumour to 20mm diameter and morphological shift to bormann type iii, histopathological evaluation of biopsy showed poorly differentiated adenocarcinoma surrounded by significant lymphocytic aggregate, immunohistochemical staining showed aggregated cells were mainly cd3+CD4+ t cells and CD20+ b cells, no CD8+ t cells observed

Remission Characteristics

2 weeks after diagnosis, surgery was performed but no tumour was found in excised specimen, histopathology showed inflammatory cell infiltration and fibrosis from the submucosal to mp layers and surface covered by regenerative mucosa without glandular cavity, no cancer cells detected, immunohistological staining of excised specimen showed significant amount of cd3+CD4+ t cells and CD20+ b cells and a few CD8+ t cells observed; cs performed 5 months after surgery showed absense of tumours in colon and rectum and ca19-9 level decreased to normal range

Treatment & Mechanisms

Proposed Remission Mechanisms

Adapatientive immunological response to the carcinoma that is mediated particularly by CD4+ t cells

Clinical Treatment

Excisional biopsy