Medullary carcinoma of the left colon in a 16-year-old male: an extremely rare case report from Syria.

INTRODUCTION AND

IMPORTANCE

Medullary carcinoma (MC) is a rare type of colon carcinoma that accounts for less than 1% of colorectal neoplasms. Morphologically, MC resembles many colorectal cancer (CRC) subtypes, mainly Neuroendocrine Carcinoma (NEC) due to exhibiting neuroendocrine features. In consequence, MC is exceedingly challenging to detect; numerous immunohistochemistry tests are required in order to distinguish it from the other subtypes of CRC.

CASE PRESENTATION: We report a case of a 16-year-old male who presented with severe abdominal pain and symptoms of bowel obstruction. Computed tomography scan showed a mass in the descending colon. The patient underwent an emergency colectomy. The left part of the transverse colon, the descending colon, and part of the sigmoid were removed, along with the regional lymph nodes. Microscopic examination suggested NEC, whereas immunohistochemical staining confirmed the diagnosis of MC of the left colon. After surgery, a course of chemotherapy was administered.

CLINICAL DISCUSSION: Medullary carcinoma usually presents in elderly Caucasian women, and is mainly observed in the right colon. Therefore, it is highly unusual to appear in a 16-year-old boy's left colon. The diagnosis is based on microscopic and immunohistochemical tests. The optimal management of MC is surgery, combined with chemotherapy, and in some cases a full colectomy is needed.

CONCLUSION

The purpose of this paper is to highlight the dilemma of diagnosing MC of the colon, as well as the successful management of MC through surgical intervention, and post-operative care.