title: A rare case of medullary carcinoma of the colon presenting as intussusception in an adult with rectal bleeding.
abstract: Medullary carcinoma is a recently recognized rare subtype of colorectal cancer resembling both poorly differentiated adenocarcinoma and neuroendocrine tumors. Medullary carcinoma most commonly presents in the proximal colon and can be differentiated from other right-sided malignant lesions by histology and immunochemical markers. We present here a rare case of an adult patient with rectal bleeding who was found to have an intussusception due to underlying medullary carcinoma of the splenic flexure. A 72-year-old woman presented to our GI clinic with rectal bleeding. Colonoscopy revealed a necrotic mass of the sigmoid colon, later determined by CT to be a colo-colonic intussusception at the level of the splenic flexure. Patient underwent diagnostic laparoscopy with findings of a large splenic flexure mass, which was resected and found to be medullary carcinoma of the colon. The tumor was poorly differentiated and exhibited microsatellite instability but was discovered at an early stage and thus did not require any adjuvant chemotherapy. Unlike most previously reported cases of medullary carcinoma, our patient presented with a left sided tumor. To our knowledge, this is the first report of a medullary colon cancer presenting with intussusception.
authors.affiliation: Gastroenterology, Private Practice, Honolulu, HI (SJ, AJ).
authors.forename: Shilpa
authors.initials: S
authors.lastname: Jain
authors.affiliation: Gastroenterology, Private Practice, Honolulu, HI (SJ, AJ).
authors.forename: Ankur
authors.initials: A
authors.lastname: Jain
authors.affiliation: Gastroenterology, Private Practice, Honolulu, HI (SJ, AJ).
authors.forename: Neil
authors.initials: N
authors.lastname: Onizuka
authors.affiliation: Gastroenterology, Private Practice, Honolulu, HI (SJ, AJ).
authors.forename: Sarag A
authors.initials: SA
authors.lastname: Boukhar
mesh_terms: D000368:Aged; D018276:Carcinoma, Medullary / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003113:Colonoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007443:Intussusception / Q000209:etiology*; D012007:Rectum; D012811:Sigmoid Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery