Atypical presentation of colon adenocarcinoma: a case report

A 27-year-old man from Kampala, Uganda, presented with gross abdominal distension, progressive loss of weight, and fever. He was initially screened for tuberculosis, hepatitis, and lymphoma, and human immunodeficiency virus/acquired immunodeficiency syndrome infection. After a battery of tests, a diagnosis of colorectal carcinoma was finally established with hematoxylin and eosin staining of a cell block made from the sediment of a liter of cytospun ascitic fluid, which showed atypical glands floating in abundant extracellular mucin, suggestive of adenocarcinoma. Ancillary tests with alcian blue/periodic acid Schiff and mucicarmine staining revealed that it was a mucinous adenocarcinoma. Immunohistochemistry showed strong positivity with CDX2, confirming that the origin of the tumor was the colon.Colorectal carcinoma has been noted to occur with increasing frequency in young adults in Africa. Most patients have mucinous adenocarcinoma, present late, and have rapid disease progression and poor outcome. Therefore, colorectal malignancy should no longer be excluded from consideration only on the basis of a patient's age. A high index of suspicion is important in the diagnosis of colorectal malignancy in young African patients.Adenocarcinoma of the colon is the most common histopathological type of colorectal carcinoma. It ranks fourth in men and third in women in Western Europe and the US and overall accounts for 98% of cancers of the large intestine [1]. This tumor has been largely associated with a 'Western' lifestyle (obesity, lack of physical activity, consumption of diets low in fruit and vegetables, and overconsumption of red meat), hence its predominance in affluent societies. In addition to lifestyle, pre-malignant conditions such as familial adenomatous polyposis coli syndrome and inflammatory bowel disease are important associated factors [2].In sub-Saharan Africa, evidence shows that the incidence of adenocarcinoma of the colon is rising and this has been at