Synchronous Trifocal Colorectal Cancer

Abstract

Synchronous colorectal cancers (SCRCs) have been increasingly diagnosed due to emerging diagnostic modalities. The presence of three or more synchronous colorectal cancers has, however, only rarely been reported. A 76-year-old white man presented for management of two concurrent colorectal adenocarcinomas in the left colon evidenced on total colonoscopy. Preoperative abdominal ultrasonography and thoracoabdominal computed tomography were negative for metastatic disease. The patient underwent an elective left hemicolectomy. The pathology report ultimately showed the presence of three moderately differentiated, distinct colorectal cancers. The patient experienced an uneventful recovery.A lthough uncommon, synchronous colorectal cancers (SCRCs) have been increasingly diagnosed due to emerging diagnostic modalities. Most patients with SCRCs present with two concurrent lesions. Th e incidence of SCRCs among colorectal cancers ranges from 2% to 11% in recent publications ( 1-14 ) ( Table ). Th e presence of three or more SCRCs has only rarely been reported. CASE PRESENTATIONA 76-year-old white man presented for management of two concurrent colorectal adenocarcinomas in the left colon (one near the splenic fl exure and one in the sigmoid colon), evidenced on total colonoscopy performed due to change of bowel habits and intermittent rectal bleeding during the past 2 months. A third polypoid lesion was encountered between these two lesions; it showed benign macroscopic features and had therefore not been biopsied. Th e colon proximal to the splenic fl exure was free of lesions. Th e patient had undergone no screening colonoscopy in the past, and his family history was negative for colorectal adenomas/cancer or hereditary nonpolyposis colorectal cancer-associated tumors. He had arterial hypertension under medication and had had a radical prostatectomy for prostate cancer 10 years earlier. Preoperative abdominal ultrasonography and thoracoabdominal computed tomography were negative for metastatic disease. Th e patient underwent an elective left hemicolectomy with a transverserectal anastomosis. Th e histological study showed the presence of three moderately diff erentiated, distinct colorectal cancers: