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Research Article
Primary medullary adenocarcinoma of the colon: Literature review and case series
1 MBBS, PGDipAnat, Faculty of Medicine University of Tasmania, Tasmania, Australia; General Surgical Department, Royal Hobart Hospital, Tasmania, Australia
2 MBBS, Department of Surgery, Royal Hobart Hospital, Tasmania, Australia
3 MBBS, Anatomical Pathology, Royal Hobart Hospital, Tasmania, Australia
4 MBBS, Faculty of Medicine University of Tasmania, Tasmania, Australia; General Surgical Department, Royal Hobart Hospital, Tasmania, Australia
5 MBBS, Department of Surgery, St George Hospital, New South Wales, Australia
6 MBBS, FRACS, Royal Hobart Hospital, Tasmania, Australia
7 MBBS, FRACS, Faculty of Medicine University of Tasmania, Tasmania, Australia; General Surgical Department, Royal Hobart Hospital, Tasmania, Australia
Address correspondence to:
Hein Maung
48 Liverpool St, Hobart, Tasmania 7000,
Australia
Message to Corresponding Author
Article ID: 100012C01HM2024
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How to cite this article
Maung H, Gregory O, Hoog TD, Hutchinson M, Soh PB, Marino M, Evans T, Yeoh A, Turner RC. Primary medullary adenocarcinoma of the colon: Literature review and case series. Edorium J Cancer 2024;8(1):1–10.ABSTRACT
Aims: Medullary carcinoma of the colon is a rare subtype of adenocarcinoma, first described in 1999. Clinically known to have a favorably prognosis in comparison to poorly differentiated cancers, it is invariably associated with mismatch gene repair. This is an observational study of Hobart’s patient population with medullary cancer, and compares data with the current literature.
Methods: We performed a search of the pathological database at our institution for medullary adenocarcinomas between the years of 2016 and 2023 and reviewed their clinical information to collect all relevant data including patient history, hospital admissions, surgery and clinic visits. We then performed a literature search using PubMed for search terms medullary cancer/carcinoma of the colon/colorectum.
Results: Eleven patients were found in our database, 34 papers in the literature (19 retrospective cohort studies and 13 case reports). 81.8% (vs. 73.22% in cohort studies) were females. 8/11 patients had lymphovascular invasion (LVI) with 2/11 patients had perineural involvement (PNI). The immunohistochemistry (IHC) results showed that in all (11/11) patients’ tumors, there was a loss of MLH1 and PMS2 proteins, while MSH2 and MSH6 proteins were present. Cohort studies demonstrated 302/1897 (15.92%) patients had perineural invasion (PNI) with 1133/2151 (52.67%) demonstrating LVI. MLH1 testing was available for 192 patients, with 93.75% having loss of MLH1.
Conclusion: Our cohort of medullary cancer patients was similar to that in the literature, with regard to demographic, staging, and tumor characteristics. A longer follow-up time is required for our cohort to produce comparable survival outcomes.
Keywords: Colon cancer, Colorectal, Primary medullary colon cancer
SUPPORTING INFORMATION
Acknowledgments
We would like to acknowledge Dr. Sunit Sarkar, Oncology Department, Royal Hobart Hospital for his contributions toward this publication.
Author ContributionsHein Maung - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Oliver Gregory - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Thomas De Hoog - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Matthew Hutchinson - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Pith Beh Soh - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Matthew Marino - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Tobias Evans - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Adrian Yeoh - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Richard C Turner - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Hein Maung et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
