Signet-ring cell carcinoma of the caecum: A case report

Abstract

Colorectal cancer (CRC) ranks as the third most prevalent cancer globally, with adenocarcinomas being the most frequent type. Signet ring cell carcinoma (SRCC) is a very rare subtype of adenocarcinoma, it commonly occurs in the stomach. However, other digestive localizations are possible including the colon, rectum, and gallbladder. Herein, we report a rare case of a metastatic caecal SRCC in a young male patient, presented to our department for abdominal diffuse pain and distention evolving for 3 months, associated with remarkable weight loss and asthenia. The clinical examination revealed abundant ascites and abdominal tenderness. Laboratory tests showed an elevated C-reactive protein at 35 mg/l (normal value: <6 mg/l), a microcytic hypochromic anemia at 11.2 g/dl (normal value for a man > 13 g/dl), increased carcinoembryonic antigen (CEA) levels, as well as CA 19-9 and CA-125.The abdominal scan showed irregular and asymmetrical thickening with peripheral speculation of the caecum measuring 2.1 cm *5.8 cm. Additionally, adjacent adenopathies, abundant ascites, and peritoneal carcinomatosis were observed to be associated with suspicious bilateral pulmonary nodules and micronodules. The colonoscopy identified a bulging ulcerative tumor of the ileocecal valve extended to the ileum. Further histologic examination confirmed the presence of signet-ring cell carcinoma. The patient was referred to the medical oncology department to initiate palliative chemotherapy following a multidisciplinary consultation meeting. We can underline that SRCC of the caecum is a rare entity with a bad prognosis. Usually, the diagnosis is made at late stages due to the lack of obvious symptoms earlier.