Adenocarcinoma of the Rectum with Choriocarcinomatous Differentiation: A case report.

, Jeong, Jae Hong; , Cho, Yong Bum; , Park, Chi Min; , Yun, Hae Ran; , Lee, Won Suk; , Suh, Yeon Lim; , Yun, Seong Hyeon; , Lee, Woo Yong; , Chun, Ho Kyung

doi:2007.23.4.274

Case Report

Journal of the Korean Society of Coloproctology 2007;23(4):274-278.
DOI: https://doi.org/10.3393/jksc.2007.23.4.274

Adenocarcinoma of the Rectum with Choriocarcinomatous Differentiation: A case report.

Jeong, Jae Hong , Cho, Yong Bum , Park, Chi Min , Yun, Hae Ran , Lee, Won Suk , Suh, Yeon Lim , Yun, Seong Hyeon , Lee, Woo Yong , Chun, Ho Kyung

¹Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea. hokyung.chun@samsung.com
²Department of Pathology, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.

Abstract

A choriocarcinoma of the rectum is extremely rare and has a very poor prognosis. Its rarity and the obscurity of its histogenesis make the entity of disease hard to define. We report a case of a choriocarcinoma of the rectum which showed synchronous liver and lung metastasis. A 52-year- old male patient presented with tenesmus, hematochezia and pain on defecation for 4 months. The preoperative colonoscopy revealed a mass at the rectum, 3 cm proximal to the anal verge. The biopsy revealed a poorly differentiated adenocarcinoma. An abdominoperineal resection was performed, and the pathologic examination confirmed a choriocarcinoma arising from an adenocarcinoma. Immunostain for beta-human chorionic gonadotropin (hCG) was strongly positive for the choriocarcinoma component. Serum hCG checked postoperatively was as high as 4,222 IU/L, but the serum carcinoembryonic antigen (CEA) was normal. Although chemotherapy was begun at the 5th week after the operation, the patient died on the 47th day after the operation. A choriocarcinoma of the colon or the rectum is very rare and is aggressive. Although radical resection and chemotherapy are performed, the clinical outcome is very disappointing. Even though a choriocarcinoma of the colon or the rectum is very rare, it should be included on the list for differential diagnosis of a colorectal carcinoma.

Key Words: Adenocarcinoma; Choriocarcinoma; Rectal cancer