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Abstract：
BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide, and screening colonoscopy has led to a decreasing incidence rate. However, the incidence of CRC is increasing among young people, especially adolescents and young adults (AYAs) who are not routinely screened. Although CRC is the fourth most common cancer among AYAs, it is extremely rare. In younger patients, CRC is often diagnosed later, and the proportion of patients with advanced CRC is higher than that in older patients. We herein present a case of poorly differentiated mucinous carcinoma of the ascending colon complicated by bilateral ovarian mature cystic teratomas (MCTs) in an AYA.
METHODS: A 17-year-old female patient presented with a chief complaint of abdominal pain and diarrhea that had persisted for more than 3 years. Colonoscopy revealed circumferential wall thickening of the ascending colon, and colonic biopsy revealed a mucous mass and findings of adenocarcinoma, predominantly signet ring cell carcinoma. Abdominal computed tomography (CT) and pelvic magnetic resonance imaging (MRI) showed bilateral ovarian tumors. Laparoscopic right hemicolectomy and enucleation of bilateral ovarian tumors were performed. Although the ascending colon cancer formed a large mass, there were no signs of peritoneal dissemination or direct invasion to the surrounding organs. Microscopically, the ascending colon was a poorly differentiated mucinous carcinoma with signet ring cell carcinoma and lymph node metastasis (9/42). The ovarian tumors were diagnosed as MCTs without any malignant components. The pathological diagnosis was ascending colon cancer (pT4aN2bM0, pStage IIIC) and bilateral ovarian MCTs. Microsatellite instability (MSI) testing was negative, and there were no gene mutations in either RAS or BRAF. Postoperative adjuvant chemotherapy with oxaliplatin and 5-FU was started.
CONCLUSIONS: We presented a case of locally advanced ascending colon cancer in a 17-year-old female patient. CRC rarely occurs in AYAs. However, the incidence has gradually increased in recent years. It should be considered as a differential diagnosis for young patients with long-term abdominal symptoms of unknown cause.
METHODS: A 17-year-old female patient presented with a chief complaint of abdominal pain and diarrhea that had persisted for more than 3 years. Colonoscopy revealed circumferential wall thickening of the ascending colon, and colonic biopsy revealed a mucous mass and findings of adenocarcinoma, predominantly signet ring cell carcinoma. Abdominal computed tomography (CT) and pelvic magnetic resonance imaging (MRI) showed bilateral ovarian tumors. Laparoscopic right hemicolectomy and enucleation of bilateral ovarian tumors were performed. Although the ascending colon cancer formed a large mass, there were no signs of peritoneal dissemination or direct invasion to the surrounding organs. Microscopically, the ascending colon was a poorly differentiated mucinous carcinoma with signet ring cell carcinoma and lymph node metastasis (9/42). The ovarian tumors were diagnosed as MCTs without any malignant components. The pathological diagnosis was ascending colon cancer (pT4aN2bM0, pStage IIIC) and bilateral ovarian MCTs. Microsatellite instability (MSI) testing was negative, and there were no gene mutations in either RAS or BRAF. Postoperative adjuvant chemotherapy with oxaliplatin and 5-FU was started.
CONCLUSIONS: We presented a case of locally advanced ascending colon cancer in a 17-year-old female patient. CRC rarely occurs in AYAs. However, the incidence has gradually increased in recent years. It should be considered as a differential diagnosis for young patients with long-term abdominal symptoms of unknown cause.
摘要：
背景：结直肠癌（CRC）是全球最常见的癌症之一，筛查结肠镜检查导致发病率下降。然而,年轻人中CRC的发病率正在增加，特别是未接受常规筛查的青少年和年轻人（AYAs）。尽管CRC是AYAs中第四常见的癌症，这是极其罕见的。在年轻患者中，CRC通常诊断较晚，晚期CRC患者的比例高于老年患者。我们在此介绍一例AYA中升结肠低分化粘液性癌并发双侧卵巢成熟囊性畸胎瘤（MCT）的病例。
方法：一名17岁女性患者主诉腹痛和腹泻，持续3年以上。结肠镜检查显示升结肠周壁增厚，结肠活检显示粘液肿块和腺癌的发现，主要是印戒细胞癌。腹部计算机断层扫描（CT）和骨盆磁共振成像（MRI）显示双侧卵巢肿瘤。行腹腔镜右半结肠切除术和双侧卵巢肿瘤摘除术。虽然升结肠癌形成了一个大肿块，没有腹膜播散或直接侵入周围器官的迹象。微观上,升结肠为低分化黏液癌伴印戒细胞癌和淋巴结转移(9/42)。卵巢肿瘤诊断为无任何恶性成分的MCT。病理诊断为升结肠癌（pT4aN2bM0，pIIIC期）和双侧卵巢MCTs。微卫星不稳定性（MSI）测试为阴性，RAS或BRAF均无基因突变。术后开始使用奥沙利铂和5-FU辅助化疗。
结论：我们介绍了一例17岁女性患者的局部晚期升结肠癌。CRC很少发生在AYAs中。然而,近年来发病率逐渐上升。应将其视为具有不明原因长期腹部症状的年轻患者的鉴别诊断。
方法：一名17岁女性患者主诉腹痛和腹泻，持续3年以上。结肠镜检查显示升结肠周壁增厚，结肠活检显示粘液肿块和腺癌的发现，主要是印戒细胞癌。腹部计算机断层扫描（CT）和骨盆磁共振成像（MRI）显示双侧卵巢肿瘤。行腹腔镜右半结肠切除术和双侧卵巢肿瘤摘除术。虽然升结肠癌形成了一个大肿块，没有腹膜播散或直接侵入周围器官的迹象。微观上,升结肠为低分化黏液癌伴印戒细胞癌和淋巴结转移(9/42)。卵巢肿瘤诊断为无任何恶性成分的MCT。病理诊断为升结肠癌（pT4aN2bM0，pIIIC期）和双侧卵巢MCTs。微卫星不稳定性（MSI）测试为阴性，RAS或BRAF均无基因突变。术后开始使用奥沙利铂和5-FU辅助化疗。
结论：我们介绍了一例17岁女性患者的局部晚期升结肠癌。CRC很少发生在AYAs中。然而,近年来发病率逐渐上升。应将其视为具有不明原因长期腹部症状的年轻患者的鉴别诊断。
