Squamous cell rectal cancer in a young woman

Czech version

Authors: Novisedláková Mária ¹; Danihel Udovít ml. ²; Oravský Milan ²; Kukučka Martin ²; Schnorrer Milan ²
Authors‘ workplace: Oddelenie klinickej onkológie, UNsP Milosrdní Bratia, Bratislava, Slovenská republika ¹; III. chirurgická klinika LF UK a UNsP Milosrdní Bratia, Bratislava, Slovenská republika ²
Published in: Klin Onkol 2021; 34(1): 62-68
Category: Case Report
doi: https://doi.org/10.48095/ccko202162

Overview

Background: Rectal squamous cell carcinoma (RSCC) belongs to rare gastrointestinal malignancies. There are no consensus recommendations for the treatment of non-metastatic RSCC, which can cause problems when considering optimal therapy.

Purpose: The objective of this report is to point out that RSCC is a rare disease which needs to be distinguished from anal squamous cell cancer (ASCC) and the treatment of which differs from that of rectal adenocarcinoma.

Case report: We discuss the diagnosis and therapy of a patient with non-metastatic RSCC. A forty-two-year-old woman with a history of diarrhea and rectal bleeding was diagnosed for RSCC with locoregional lymphadenopathy, stage T3N1MO. Protective sigmostomy was performed for stenotizing tumor; then the patient underwent chemoradiotherapy with the effect of complete response in MR scans. Subsequently, the patient underwent rectal resection according to Dixon with histological confirmation of complete tumor regression and without detection of residual tumor in the rectum.

Conclusion: It can be sometimes difficult to distinguish primary RSCC from ASCC. Nowadays, there is no standardized staging system for RSCC, and it causes problems in comparative studies as well as in the determination of treatment protocols. The backbone of RSCC treatment is chemoradiotherapy.

Keywords:

squamous cell – rectal cancer – radiotherapy – Chemotherapy – tumor staging

Sources

1. Guerra GR, Kong CH, Warrier SK et al. Primary squamous cell carcinoma of the rectum: An update and implications for treatment. World J Gastrointest Surg 2016; 8 (3): 252–265. doi: 10.4240/wjgs.v8.i3.252.

2. Dutta SW, Alonso CE, Waddle MR et al. Squamous cell carcinoma of the rectum: Practice trends and patient survival. Cancer Med 2018; 7 (12): 6093–6103. doi: 10.1002/cam4.1893.

3. Kang H, O’Connell JB, Leonardi MJ et al. Rare tumors of the colon and rectum: a national review. Int J Colorectal Dis 2007; 22 (2): 183–189. doi: 10.1007/s00384-006- 0145-2.

4. Stanojević G, Kripokapič Z. Rare tumors of the colon and rectum. Colorectal cancer – surgery, diagnostics and treatment 2014: 254–267. doi: 10.5772/56937.

5. Gordon Ph. Malignant neoplasms of the colon. In: Gordon Ph, Nivatvongs S (eds). Principles and practice of the surgery for the colon rectum and anus. New York: CRC Press 2007: 489–645.

6. Schmidtmann M. Zur Kenntnis seltner Krebsformen. Virchow Arch (A) 1919; 226: 100–118.

7. Kiyani A, Coyle WJ, Bao F. A rare case of primary rectal squamous cell carcinoma diagnosed by endoscopic ultrasound. J Gastrointest Oncol 2017; 8 (4): 56–59. doi: 10.21037/jgo.2017.06.04.

8. Williams GT, Blackshaw AJ, Morson BC. Squamous carcinoma of the colorectum and its genesis. J Pathol 1979; 129 (3): 139–147. doi: 10.1002/path.1711290306.

9. Zirkin RM, Mccord DL. Squamous cell carcinoma of the rectum: report of a case complicating chronic ulcerative colitis. Dis Colon Rectum 1963; 6: 370–373. doi: 10.1007/BF02618400.

10. Nahas CS, Shia J, Joseph R et al. Squamous-cell carcinoma of the rectum: a rare but curable tumor. Dis Colon Rectum 2007; 50: 1393–1400. doi: 10.1007/s10350-007-0256-z.

11. Chiu MS, Verma V, Bennion NR et al. Comparison of outcomes between rectal squamous cell carcinoma and adenocarcinoma. Cancer Med 2016; 5 (12): 3394–3402. doi: 10.1002/cam4.927.

12. Glimelius B, Tiret E, Cervantes A et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and followup. Ann Oncol 2013; 24 (suppl 6): vi81–vi88. doi: 10.1093/annonc/mdt240.

13. National Comprehensive Cancer Network. Rectal cancer (version 1.2018). [online]. Available from: https: //www.nccn.org/professionals/physician_gls/pdf/ rectal.pdf.

14. Nigro ND, Seydel HG, Considine B et al. Combined preoperative radiation and chemotherapy for squamous cell carcinoma of the anal canal. Cancer 1983; 51 (10): 1826–1829. doi: 10.1002/1097-0142 (19830515) 51: 10<1826:: aid-cncr2820511012>3.0.co; 2- l.

15. Kulaylat AS, Hollenbeak CS, Stewart DB Sr. Squamous cancers of the rectum demonstrate poorer survival and increased need for salvage surgery compared with squamous cancers of the anus. Dis Colon Rectum 2017; 60 (9): 922–927. doi: 10.1097/DCR.0000000000000 881.

16. Leeds IL, Griffin JF, Fang SH. Distinguishing anal squamous cell carcinoma and rectal squamous cell carcinoma in secondary data sets. Dis Colon Rectum 2018; 61 (3): e19. doi: 10.1097/DCR.0000000000001015.

17. Goffredo P, Robinson TJ, Frakes JM. Comparison of anal versus rectal staging in the prognostication of rectal squamous cell carcinoma: a population-based analysis. Dis Colon Rectum 2019; 62 (3): 302–308. doi: 10.1097/DCR.0000000000001205.

18. Raiford T. Epithelioma of the lower rectum and anus. Surg Gynaecol Obstet 1933; 57: 21–35. doi: 10.1080/00325481.1950.11693937.

19. Catell RB, Williams AG. Epidermoid carcinoma of the anus and rectum. Arch Surg 1943; 46 (3): 336–349. doi: 10.1001/archsurg.1943.01220090031003.

20. LeBlanc LJ, Buie LA, Dockerty MB. Squamous-cell epithelioma of the rectum. Ann Surg 1950; 131 (3): 392–399. doi: 10.1097/00000658-195003000-00010.

21. O’Brien JP, Meehan DJ. Squamous cell carcinoma of the rectum. Ann Surg 1951; 133 (2): 283–285.

22. Kron SD, Wurzel HA, Chodoff RJ. Squamous cell carcinoma of the rectum. Gastroenterology 1951; 17: 194–197.

23. Dixon CF, Dockerty MB, Powelson MH. Squamous cell carcinoma of the midrectum: report of case. Proc Staff Meet Mayo Clin 1954; 29 (15): 420–423.

24. Burns FJ. Squamous cell carcinoma of the rectum. Mo Med 1955; 52 (1): 31.

25. Wiener MF, Polayes SH, Yidi R. Squamous carcinoma with schistosomiasis of the colon. Am J Gastroenterol 1962; 37: 48–54.

26. Hohm WH, Jackman RJ. Squamous cell carcinoma of the rectum complicating ulcerative colitis: report of two cases. Mayo Clin Proc 1964; 39: 249–251.

27. Angelchik JP, Epstein J. Squamous cell carcinoma of the upper rectum. Ariz Med 1967; 24 (1): 19–21.

28. Cabrera A, Pickren JW. Squamous metaplasia and squamous-cell carcinoma of the rectosigmoid. Dis Colon Rectum 1967; 10 (4): 288–297. doi: 10.1007/BF02617 142.

29. Minkowitz S. Primary squamous cell carcinoma of the rectosigmoid portion of the colon. Arch Pathol 1967; 84 (1): 77–80.

30. Higton DI. Squamous cell carcinoma of rectum. Proc R Soc Med 1970; 63 (8): 754.

31. Comer TP, Beahrs OH, Dockerty MB. Primary squamous cell carcinoma and adenocanthoma of the colon. Cancer 1971; 28: 1111–1117.

32. Vezeridis MP, Herrera LO, Lopez GE et al. Squamous-cell carcinoma of the colon and rectum. Dis Colon Rectum 1983; 26 (3): 188–191. doi: 10.1007/BF02560169.

33. Lafreniere R, Ketcham AS. Primary squamous carcinoma of the rectum. Report of a case and review of the literature. Dis Colon Rectum 1985; 28 (12): 967–972. doi: 10.1007/BF02554319.

34. Pigott JP, Williams GB. Primary squamous cell carcinoma of the colorectum: case report and literature review of a rare entity. J Surg Oncol 1987; 35 (2): 117–119. doi: 10.1002/jso.2930350211.

35. Woods WG. Squamous cell carcinoma of the rectum arising in an area of squamous metaplasia. Eur J Surg Oncol 1987; 13 (5): 455–458.

36. Prener A, Nielsen K. Primary squamous cell carcinoma of the rectum in Denmark. APMIS 1988; 96 (9): 839–844. doi: 10.1111/j.1699-0463.1988.tb00951.x.

37. Schneider TA, Birkett DH, Vernava AM. Primary adenosquamous and squamous cell carcinoma of the colon and rectum. Int J Colorectal Dis 1992; 7 (3): 144–147. doi: 10.1007/BF00360355.

38. Fazzi U, Anderson JR. Squamous carcinoma of the rectum. Br J Clin Pract 1994; 48 (2): 106–107. doi: 10.4240/wjgs.v8.i3.252.

39. Copur S, Ledakis P, Novinski D et al. Squamous cell carcinoma of the colon with an elevated serum squamous cell carcinoma antigen responding to combination chemotherapy. Clin Colorectal Cancer 2001; 1 (1): 55–58. doi: 10.3816/CCC.2001.n.006.

40. Frizelle FA, Hobday KS, Batts KP et al. Adenosquamous and squamous carcinoma of the colon and upper rectum: a clinical and histopathologic study. Dis Colon Rectum 2001; 44 (3): 341–346. doi: 10.1007/BF02234730.

41. Sotlar K, Köveker G, Aepinus C et al. Human papillomavirus type 16-associated primary squamous cell carcinoma of the rectum. Gastroenterology 2001; 120 (4): 988–994. doi: 10.1053/gast.2001.22523.

42. Gelas T, Peyrat P, Francois Y et al. Primary squamous-cell carcinoma of the rectum: report of six cases and review of the literature. Dis Colon Rectum 2002; 45 (11): 1535–1540. doi: 10.1007/s10350-004-6462-z.

43. Anagnostopoulos G, Sakorafas GH, Kostopoulos P et al. Squamous cell carcinoma of the rectum: a case report and review of the literature. Eur J Cancer Care (Engl) 2005; 14 (1): 70–74. doi: 10.1111/j.1365-2354.2005.00523.x.

44. Fahim F, Al-Salamah SM, Alam MK et al. Squamous cell carcinoma of colon and rectum. Saudi Med J 2006; 27 (6): 874–877.

45. Lam AK, Ho YH. Primary squamous cell carcinoma of the rectum in a patient on immunosuppressive therapy. Pathology 2006; 38 (1): 74–76. doi: 10.1080/00313020500467113.

46. Cheng H, Sitrin MD, Satchidanand SK et al. Colonic squamous cell carcinoma in ulcerative colitis: report of a case and review of the literature. Can J Gastroenterol 2007; 21 (1): 47–50. doi: 10.1155/2007/904081.

47. Kong CS, Welton ML, Longacre TA. Role of human papillomavirus in squamous cell metaplasia-dysplasia-carcinoma of the rectum. Am J Surg Pathol 2007; 31 (6): 919–925. doi: 10.1097/01.pas.0000213441.86030.fc.

48. Leung KK, Heitzman J, Madan A. Squamous cell carcinoma of the rectum 21 years after radiotherapy for cervical carcinoma. Saudi J Gastroenterol 2009; 15 (3): 196–198. doi: 10.4103/1319-3767.54745.

49. Dzeletovic I, Pasha S, Leighton JA. Human papillomavirus-related rectal squamous cell carcinoma in a patient with ulcerative colitis diagnosed on narrow-band imaging. Clin Gastroenterol Hepatol 2010; 8 (5): e47–e48. doi: 10.1016/j.cgh.2009.10.019.

50. Sameer AS, Syeed N, Chowdri NA et al. Squamous cell carcinoma of rectum presenting in a man: a case report. J Med Case Rep 2010; 4: 392. doi: 10.1186/1752-1947-4-392.

51. Wang ML, Heriot A, Leong T et al. Chemoradiotherapy in the management of primary squamous-cell carcinoma of the rectum. Colorectal Dis 2011; 13 (3): 296–301. doi: 10.1111/j.1463-1318.2009.02154.x.

52. Sanal SM, Sivrikoz ON, Karapolat I et al. Complete clinical response in squamous cell carcinoma of the rectum with liver metastases. J Clin Oncol 2011; 29 (33): e806–e808. doi: 10.1200/JCO.2011.36.7292.

53. Yeh J, Hastings J, Rao A et al. Squamous cell carcinoma of the rectum: a single institution experience. Tech Coloproctol 2012; 16 (5): 349–354. doi: 10.1007/s10151-012-0848-z.

54. Faidzal O, Azmi MN, Kalavathi R. Primary squamous cell carcinoma of the rectum: a case report. IMJM 2013; 12: 87. doi: 10.3402/jchimp.v6.31708.

55. Wang JF, Wang ZX, Xu XX et al. Primary rectal squamous cell carcinoma treated with surgery and radiotherapy. World J Gastroenterol 2014; 20 (14): 4106–4109. doi: 10.3748/wjg.v20.i14.4106.

56. Scaringi S, Bisogni D, Messerini L et al. Squamous cell carcinoma of the middle rectum: report of a case and literature overview. Int J Surg Case Rep 2015; 7C: 127–129. doi: 10.1016/j.ijscr.2014.10.097.

57. Ozuner G, Aytac E, Gorgun E et al. Colorectal squamous cell carcinoma: a rare tumor with poor prognosis. Int J Colorectal Dis 2015; 30 (1): 127–130. doi: 10.1007/s00384-014-2058-9.

58. Péron J, Bylicki O, Laude C et al. Nonoperative management of squamous-cell carcinoma of the rectum. Dis Colon Rectum 2015; 58 (1): 60–64. doi: 10.1097/DCR.000 0000000000218.

59. Schneider TA, Birkett DH, Vernava AM. Primary adenosquamous and squamous cell carcinoma of the colon and rectum. Int J Colorectal Dis 1992; 7 (3): 144–147. doi: 10.1007/BF00360355.

60. Kulaylat MN, Doerr R, Butler B et al. Squamous cell carcinoma complicating idiopathic inflammatory bowel disease. J Surg Oncol 1995; 59 (1): 48–55. doi: 10.1002/jso.2930590113.

61. Martinez-Gonzalez MD, Takahashi T, Leon-Rodriguez E et al. Case report of primary squamous carcinoma of the rectum. Rev Invest Clin 1996; 48 (6): 453–456.

62. Theodosopoulos TK, Marinis AD, Dafnios NA et al. Aggressive treatment of metastatic squamous cell carcinoma of the rectum to the liver: a case report and a brief review of the literature. World J Surg Oncol 2006; 4: 49. doi: 10.1186/1477-7819-4-49.

63. Pikarsky AJ, Belin B, Efron J et al. Squamous cell carcinoma of the rectum in ulcerative colitis: case report and review of the literature. Int J Colorectal Dis 2007; 22 (4): 445–447. doi: 10.1007/s00384-006-0110-0.

64. Clark J, Cleator S, Goldin R et al. Treatment of primary rectal squamous cell carcinoma by primary chemoradiotherapy: should surgery still be considered a standard of care. Eur J Cancer 2008; 44 (16): 2340–2343. doi: 10.1016/j.ejca.2008.07.004.

65. Matsuda A, Takahashi K, Yamaguchi T et al. HPV infection in an HIV-positive patient with primary squamous cell carcinoma of rectum. Int J Clin Oncol 2009; 14 (6): 551–554. doi: 10.1007/s10147-009-0890-7.

66. Brammer RD, Taniere P, Radley S. Metachronous squamous-cell carcinoma of the colon and treatment of rectal squamous carcinoma with chemoradiotherapy. Colorectal Dis 2009; 11 (2): 219–220. doi: 10.1111/j.1463-1318.2008.01577.x.

67. Rasheed S, Yap T, Zia A et al. Chemo-radiotherapy: an alternative to surgery for squamous cell carcinoma of the rectum-report of six patients and literature review. Colorectal Dis 2009; 11 (2): 191–197. doi: 10.1111/j.1463-1318.2008.01560.x.

68. Al Hallak MN, Hage-Nassar G, Mouchli A. Primary submucosal squamous cell carcinoma of the rectum diagnosed by endoscopic ultrasound: case report and literature review. Case Rep Gastroenterol 2010; 4 (2): 243–249. doi: 10.1159/000319013.

69. Tronconi MC, Carnaghi C, Bignardi M et al. Rectal squamous cell carcinoma treated with chemoradiotherapy: report of six cases. Int J Colorectal Dis 2010; 25 (12): 1435–1439. doi: 10.1007/s00384-010-0988-4.

70. Iannacone E, Dionisi F, Musio D et al. Chemoradiation as definitive treatment for primary squamous cell cancer of the rectum. World J Radiol 2010; 2 (8): 329–333. doi: 10.4329/wjr.v2.i8.329.

71. Jeong BG, Kim DY, Kim SY. Concurrent chemoradiotherapy for squamous cell carcinoma of the rectum. Hepatogastroenterology 2013; 60 (123): 512–516. doi: 10.5754/hge11293.

72. Kassir R, Baccot S, Bouarioua N et al. Squamous cell carcinoma of middle rectum: literature review. Int J Surg Case Rep 2014; 5 (2): 86–90. doi: 10.1016/j.ijscr.2013.12. 011.

73. Ferreira AO, Loureiro AL, Marques V et al. Primary squamous cell carcinoma of the most distal rectum: a dilemma in origin and management. BMJ Case Rep 2014; 2014: bcr2013201156. doi: 10.1136/bcr-2013-201 156.

74. Choi H, Lee HW, Ann HW et al. A case of rectal squamous cell carcinoma with metachronous diffuse large B cell lymphoma in an HIV-infected patient. Infect Chemother 2014; 46 (4): 257–260. doi: 10.3947/ic.2014.46.4.257.

75. Musio D, De Felice F, Manfrida S et al. Squamous cell carcinoma of the rectum: the treatment paradigm. Eur J Surg Oncol 2015; 41 (8): 1054–1058. doi: 10.1016/j.ejso.2015.03.239.

76. Funahashi K, Nemoto T, Koike J et al. Chemoradiation therapy with S-1 for primary squamous cell carcinoma of the rectum: report of three cases. Surgical Case Reports 2015; 1 (1): 1–7. doi: 10.1186/s40792-015-0025-5.

77. Seshadri RA, Pancholi M, Jayanand SB et al. Squamous cell carcinoma of the rectum: is chemoradiation sufficient. J Cancer Res Ther 2015; 11 (3): 664. doi: 10.4103/0973-1482.143350.