Squamous cell carcinoma of the rectum 21 years after radiotherapy for cervical carcinoma

Abstract

Squamous cell carcinoma (SCC) of the rectum is an extremely rare malignancy, accounting for 0.1-0.2% of rectal malignancies. It is associated with ulcerative colitis, prior radiation, schistosomiasis, ovarian cancer, endometrial cancer, human papilloma virus, colocutaneous fistulas and colonic duplication. Prior reported cases of SCC of the rectum have involved treatment with brachytherapy and external beam radiation. This case is particularly interesting because of the remote exposure of radiation (21 years previously) and the subsequent development of SCC of the rectum. Although extremely rare, SCC of the rectum can occur decades after radiation exposure.

Primary Squamous Cell Carcinoma of the Cecum Presenting as Spontaneous Perforation

“…Suggested infectious etiologies include HPV (human papillomavirus), schistosomiasis, and Entamoeba histolytica. A history of previous surgical procedures or radiation therapy has been found in patients with colonic SCC [5]. Hicks and Cowling described the possibility of pluripotent stem cells capable of squamous differentiation [6].…”

An interesting case of primary squamous cell carcinoma of the colon with synchronous metastatic adenocarcinoma

“…Primary squamous cell cancer (SCC) of the bowel is an extremely rare entity, accounting for 0.1–0.2% of all colorectal malignancies [ 1 , 2 ]. The first ever described case of SCC bowel was in 1919 by Schmidtmann [ 3 ].…”

“…Thirdly, inflammation secondary to infection or inflammatory bowel disease has been implicated [ 6 ]. The presence of squamous cell differentiation in other adenocarcinomas has also led some to believe that these cancers may develop from established adenocarcinomas or adenomas [ 2 , 5 , 6 ]. As such, primary SCC colon has been associated with ulcerative colitis, prior radiation, ovarian cancer, endometrial cancer, schistosomiasis human papilloma virus, colocutaneous fistulas, and colonic duplication [ 2 , 5 ].…”

Primary Submucosal Squamous Cell Carcinoma of the Rectum Diagnosed by Endoscopic Ultrasound: Case Report and Literature Review

“…Lam and Ho proposed the pathogenesis to be related to the oncogenic effect of chronic renal failure and long-term use of immunosuppressive therapy in the way the carcinogenic viruses or the direct carcinogenic effect of the immunosuppressive therapy may account for the activation of uncommitted stem cells in the pathogenesis of SCC [ 19 ]. There has been some possible association between colorectal SCC and previous radiation exposure [ 11 , 12 ], colocutaneous fistula [ 13 ], ulcerative colitis [ 14 ], Entamoeba histolytica colitis [ 9 ], duplication of the colon [ 20 ], homosexual men [ 21 ], immunossupression [ 19 ], schistosomiasis [ 15 ] and a controversial association with HPV [ 22 , 23 ].…”

“…The etiology of colorectal SCC is still unclear. Different proposals regarding its origin and its relation to other entities have been reported in the literature [ 2 , 8 9 10 11 12 13 14 15 ]. We report a case of primary submucosal colorectal SCC which was diagnosed based on endoscopic ultrasound (EUS) fine needle biopsy and treated successfully with chemoradiation without preceded surgery upon the patient's request.…”