Abstract Background: Colorectal carcinoma (CRC) is a major adult malignancy and remains exceedingly rare in the pediatric population, often diagnosed at advanced stages due to nonspecific clinical manifestations and subtle endoscopic findings. Signet cell adenocarcinoma, a rare histological variant, is associated with aggressive behavior, diffuse infiltration, early peritoneal spread, and poor prognosis. Clinical Description: An 11-year-old boy presented with massive abdominal distention, pain, weight loss, and occasional vomiting for 3 months without fever or blood in stools. Examination revealed significant malnutrition, pallor, ascites and inguinal lymphadenopathy, without hepatosplenomegaly. Management and Outcome: Imaging revealed diffuse circumferential thickening of the sigmoid colon and rectum with omental and peritoneal deposits. Colonoscopy detected a stony hard, indurated rectosigmoid lesion, and biopsy demonstrated poorly differentiated adenocarcinoma with signet ring morphology. Immunohistochemistry showed intact mismatch repair proteins, confirming an MMR-proficient tumor. Considering the child’s advanced disease stage and poor functional status, aggressive multimodality therapy was deferred. Repeated paracenteses for symptomatic relief and oral capecitabine chemotherapy were all that could be provided. Conclusion: This case underscores the importance of considering CRC in children with atypical gastrointestinal symptoms and doing appropriate investigations for early diagnosis.
Grotra et al. (Wed,) studied this question.