PMC8627336_01
Colonoscopy findings of stenotic rectal mass.
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The patient underwent an urgent colonoscopy which showed a malignant-looking lesion with severe stenosis at the proximal rectum 10 cm from the anal verge (Figure 1).
(a) Rectal biopsy showing signet ring cells (yellow arrow). (b) Rectal biopsy positive for cytokeratin 7 immunostain.
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A biopsy was taken and revealed few signet ring cells with CK7 histochemical stains being positive while CK20 and CDX2 were negative (Figures 2(a) and 2(b)).
CT of the abdomen and pelvis in coronal view (a) showing a rectal mass and in axial view (b) showing small noncalcific right internal (red arrow) and right external (yellow arrow) iliac lymph nodes.
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Whole body PET/CT showing right breast suspicious mass.
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Diagnostic laparoscopy showing multiple peritoneal metastatic lesions.
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In view of the almost complete bowel obstruction, the patient underwent laparoscopic diverting loop ileostomy to relieve the symptoms, which also showed disseminated peritoneal metastatic deposits (Figure 5) that were biopsied and turned out to be metastatic carcinoma, showing sheets of pleomorphic malignant signet ring-like cells on histopathology.
(a) Peritoneal deposit biopsy showing discohesive cells with plasmacytoid and signet ring morphology. (b) Peritoneal deposit biopsy showing sheets of malignant cells positive for estrogen receptors (ER).
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CK7 and estrogen receptors (ER) were positive (Figures 6(a) and 6(b)) and CK20, GCDFP-15, E-cadherin, WT-1, and Her-2 Neu were negative on immunohistochemistry staining.
(a) Two lesions in the right breast on mammogram (blue arrows). (b) Right breast lesion.
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Right breast lesion biopsy showing invasive lobular carcinoma, arranged in sheets, cords, and small clusters.
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