TOTAL COLECTOMY IN A PATIENT WITH THREE SYNCHRONOUS COLORECTAL TUMORS: A CASE REPORT

Case Report A 63-year-old woman presented with abdominal pain, diarrhea, and hematochezia. Physical examination showed no abnormalities. Initial CEA level was 32. CT scan revealed thickening in the descending colon and a hepatic nodule suggestive of a secondary implant. Colonoscopy showed a vegetating lesion in the sigmoid and descending colon, preventing the passage of the scope. The patient underwent total colectomy with ileorectal anastomosis and hepatic metastasectomy. The pathological examination confirmed 3 synchronous tumors (lesions in the sigmoid colon, descending colon, and a polyp in the ascending colon), all adenocarcinomas with mucinous areas. Immunohistochemistry showed microsatellite stability and a KRAS gene mutation. The patient is currently under follow-up and receiving adjuvant therapy.

Discussion Synchronous colorectal cancer refers to the presence of simultaneous tumors in a patient at initial presentation. The prevalence is 3.5%, and the occurrence of 3 or more tumors is rare. Literature reports a higher prevalence of synchronous tumors in males and elderly patients. There is also a tendency for greater involvement of the ascending colon and mucinous pathology. Risk factors include inflammatory bowel disease, Lynch syndrome, and familial adenomatous polyposis, as well as genetic and molecular factors such as microsatellite instability and mutations in BRAF, KRAS, and p53 genes. Preoperative diagnosis is often challenging. Complete colonoscopy is frequently hindered due to obstructive tumors. CT scans have good sensitivity. Virtual colonoscopy, MRI, and PET scans can be useful, especially when the colonoscopy is incomplete or if synchronous lesions are suspected. Treatment should consider tumor location, staging, and the patient's general condition. Studies recommend total colectomy to resect potentially undiagnosed lesions and prevent metachronous tumors. However, others recommend traditional surgery to preserve the colon. In the presented case, a rare occurrence of 3 synchronous colorectal tumors was observed. The patient had only the KRAS gene mutation as a risk factor. The preoperative colonoscopy identified two lesions, with the third lesion diagnosed only in the pathological examination.

Conclusion This case highlights the importance of studying clinical and molecular risk factors in the pathophysiology of synchronous colorectal lesions, as well as discussing the diagnosis and particularities of treatment, which remain controversial.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025