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Microsatellite instability in medullary carcinoma of the colon

Mario Martinotti, Fernando Cirillo, Marco Ungari, Giulia Tanzi, Giovanni Rolando, Antonio Tarasconi, Valerio Ranieri, Paolo Aulisa, Marco Vismarra, Massimo Rovatti, Monica Trombatore
  • Mario Martinotti
    Department of Surgery, General Surgery Unit, ASST Istituti Ospitalieri, Cremona, Italy
  • Fernando Cirillo
    Rare Hormonal Tumors Group, ASST Istituti Ospitalieri, Cremona, Italy
  • Marco Ungari
    Department of Pathology, ASST Istituti Ospitalieri, Cremona, Italy
  • Giulia Tanzi
    Department of Pathology, ASST Istituti Ospitalieri, Cremona, Italy
  • Giovanni Rolando
    Department of Surgery, General Surgery Unit, ASST Istituti Ospitalieri, Cremona, Italy | rolando.gio@libero.it
  • Antonio Tarasconi
    Department of Surgery, General Surgery Unit, ASST Istituti Ospitalieri, Cremona, Italy
  • Valerio Ranieri
    Department of Surgery, General Surgery Unit, ASST Istituti Ospitalieri, Cremona, Italy
  • Paolo Aulisa
    Department of Surgery, General Surgery Unit, ASST Istituti Ospitalieri, Cremona, Italy
  • Marco Vismarra
    Department of Surgery, General Surgery Unit, ASST Istituti Ospitalieri, Cremona, Italy
  • Massimo Rovatti
    Department of Surgery, General Surgery Unit, ASST Istituti Ospitalieri, Cremona, Italy
  • Monica Trombatore
    Department of Pathology, ASST Istituti Ospitalieri, Cremona, Italy

Abstract

Medullary carcinoma (MC) of the large intestine is a relatively new histological type of adenocarcinoma characterized by poor glandular differentiation and an intraepithelial lymphocytic infiltrate. MC can be associated to a defective mechanism for DNA mismatch repair, caused by the so-called microsatellite instability (MSI). We present the case of a 44 years old Caucasian woman, who referred to the Emergency Room with symptoms mimicking an acute appendicitis. Computed tomography and colonoscopy demonstrated an ulcerated and stenotic lesion of the caecum without signs of metastasis and peritoneal carcinosis. Patient underwent a laparoscopic right colectomy. The final pathologic findings provided the diagnosis of medullary carcinoma with MSI. Patient then underwent adjuvant chemotherapy according to the FOLFOX- 4 protocol (association of 5-Fluorouracil, Leucovorin, and Oxaliplatin) for twelve cycles. At two-years follow-up, patient is disease free. MC in association with MSI is a non-frequent tumor of the colon characterized by a better prognosis compared to other types of poorly differentiated adenocarcinoma. In the observed case, 24 months after the surgical operation, the patient is in good health and there is no evidence of metastasis or relapse.

Keywords

medullary carcinoma; microsatellite instability; colorectal carcinoma

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Submitted: 2016-04-20 14:41:39
Published: 2017-03-30 13:58:14
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Copyright (c) 2017 Mario Martinotti, Fernando Cirillo, Marco Ungari, Giulia Tanzi, Giovanni Rolando, Antonio Tarasconi, Valerio Ranieri, Paolo Aulisa, Marco Vismarra, Massimo Rovatti, Monica Trombatore

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