A rare case of synchronous gastrointestinal malignancy- a case report

Abstract

Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch
syndrome, is a autosomal dominant syndrome characterized by early age onset neoplastic lesions of
colon, andmicrosatellite instability (MSI). HNPCC accounts for 2-10 of all the colorectal cancer
cases1, commonly involving left sided or distal colon2, but in our case right side of the colon was
involved. We present one such case with involvement of stomach and colon together. Case A 46 year
old male presented with large bowel type diarrhea, pain abdomen , weight loss and appetite loss with
a significant family history of colon malignancy among 2 first degree relatives. On investigating, blood
investigations were normal except for anemia. Colonoscopy and gastroscopy revealed , multiple
colonic polyposis(15-20) with circumferential proliferative growth at ascending colon and ulceroproliferative
growth at antrum respectively. Histopathology examinations of colonic antral growth
showed moderately differentiated adenocarcinoma and poorly differentiated adenocarcinoma
respectively. so with 2 first degree relatives with colon cancer and the patient diagnosed with gastric
colon cancer, he satisfies the Amsterdam criteria for HNPCC. Hence tested for MSI for confirmation
which came positive for MLH1 and MSH2. CECT abdomen was done for staging the disease and
staged as T3N0M0. So curative surgery was done in a single attempt with a successful recovery.
Conclusion HNPCC is an uncommon syndrome but synchronous presentation is very rare
presentation. One stage radical surgery was the successful attempt resulting in curative surgical
management .In a patients with family history of colorectal cancer the possibility of HNPCC must be
considered so that appropriate surveillance can be instituted, which can reduce the mortality.
Keyword :CECT- contrast enhanced computed tomography, HNPCC-herediatry non polyposis colon
cancer, MSI-microsatellite instability,ECG-electrocardiogram,GIT-gastrointestinal tract