title: Large cell neuroendocrine - Adenocarcinona mixed tumour of colon: Collision tumour with peculiar behaviour. What do we know about these tumours?
abstract: BACKGROUND
  Mixed glandular-endocrine carcinomas are rare tumours of gastrointestinal tract (MANEC). They are more frequent in stomach and hardly one hundred cases have been described in colon. According to Lewis, they are classified into collision (side by side pattern), composite (intermingled) or amphicrine (neuroendocrine and glandular features inside a same cell). Collision tumours are related to biclonal theory: two simultaneous cancerogenic events. Conversely, multidirectional differentiation from a stem cell is accepted as origin of composite tumours. The aim of this paper is to analyse the behaviour of these tumours, with an especial concern about how these tumours metastasise, and the different theories about carcinogenesis.
  
  
  METHODS
  We report a rare case of collision adenocarcinoma-large cell neuroendocrine tumour of colon that after a three-year period of follow-up has presented a retroperitoneal recurrence that features adenocarcinoma and large cell neuroendocrine components.
  
  
  CONCLUSIONS
  After an exhaustive review of the English literature, we found that only two cases of collision tumour of colon with metastases showing glandular and endocrine components have been described up to date, so we report the third case, and the first happening in transverse colon.
  
  
  CONCLUSIONS
  We conclude that not all collision tumours follow the biclonal theory and more studies are needed to clarify the origin of these neoplasms, and consequently, to reach an adequate treatment.
authors.affiliation: Principe de Asturias Hospital, Department of General Surgery, Carretera Alcala, Meco s/n, CP 28805, Alcala de Henares, Madrid, Spain.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Minaya-Bravo
authors.affiliation: Freelance, Madrid, Spain.
authors.forename: Julio Cesar
authors.initials: JC
authors.lastname: Garcia Mahillo
authors.affiliation: Principe de Asturias Hospital, Department of General Surgery, Alcala de Henares, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mendoza Moreno
authors.affiliation: Principe de Asturias Hospital, Department of General Surgery, Alcala de Henares, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Noguelares Fraguas
authors.affiliation: Principe de Asturias Hospital, Department of General Surgery, Alcala de Henares, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Granell
keywords: Collision; Colon; Composite; MANEC; Mixed; Tumour