|Year : 2013 | Volume
| Issue : 4 | Page : 739-740
Primary squamous cell carcinoma of the small intestine
Shirish S Nandedkar1, Karunakar K Trivedi2, Kamal Malukani1
1 Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
2 Department of Surgery, Shri Indore Cloth Market Hospital, Indore, Madhya Pradesh, India
|Date of Web Publication||11-Feb-2014|
Shirish S Nandedkar
6 Subhash Marg, Opposite M.S. High School, Indore - 452 007, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Squamous cell carcinoma of the small intestine is very rare. Only four cases have been reported so far. We report a case of primary squamous cell carcinoma arising in the small intestine and unusually causing strangulation of sigmoid colon in a 59-year-old female, the first case in India.
Keywords: Primary, sigmoid colon, small intestine, squamous cell carcinoma
|How to cite this article:|
Nandedkar SS, Trivedi KK, Malukani K. Primary squamous cell carcinoma of the small intestine. J Can Res Ther 2013;9:739-40
| > Introduction|| |
Small intestine excluding duodenum is a rare site for malignancy and constitute only 3.46% of all the Gastro-intestinal malignancies.  Careful search of medical literature revealed only four cases of primary squamous cell carcinoma in small intestine ,,, excluding duodenum, where three cases have been reported.  Besides these cases, small bowel metastasis  and squamous cell carcinoma arising in duplication cyst  have been reported.
| > Case Report|| |
A 59-year-old female came with the complaints of pain in the lower abdomen, loss of appetite, and loose motions on and off for last 2 months. On examination she was averagely built and nourished with soft abdomen. Liver, spleen or abdominal lump were not palpable. There was no oral or pulmonary lesions or no clinical complaints of the patient related to that. Hematological investigations revealed severe microcytic hypochromic anemia (Hemoglobin 5.6 g%). X-ray chest, blood glucose and creatinine were normal. Ultrasonography of abdomen revealed ill-defined hypo-echoic wall thickening in the sigmoid colon of possibly inflammatory origin with atrophic uterus cervix. computed tomography (CT) abdomen showed symmetric wall thickening of proximal sigmoid with marked peri-colic strangling without significant proximal colonic obstruction associated with pericolic and mesenteric lymphadenopathy of probably inflammatory origin. Colonic endoscopy revealed recto-sigmoid stricture with no mucosal abnormality. The endoscopic biopsy taken was unremarkable.
Based on the above findings the patient was taken for laparotomy with the provisional clinical diagnosis of Koch's abdomen. During the surgery the small intestine was found to be adherent to sigmoid colon with its anti-mesenteric border and a band seen encircling the sigmoid colon with multiple nodules over mesentery and peritoneum. Involved small intestine was resected with excision of the peri-colic band, mesenteric and peritoneal nodules, which were thought to be lymph nodes.
Sigmoid colon dilated after excision of encircling band. As imaging and intra-operative findings were suggestive of inflammatory lesion, excision of sigmoid colon was not carried out.
In Histopathology Department, a 15 cm long piece of small intestine [Figure 1] with multiple irregular soft-tissue pieces pearly white in appearance, were received. Lymph nodes were not identified. The small intestinal piece showed an ulcer in the mid portion measuring 4.0 cm × 2.0 cm. On the mucosal surface involving only half of the circumference at the anti-mesenteric side and no intraluminal growth was seen.
|Figure 1: Gross specimen of a piece of unopened small intestine showing irregular serosal surface|
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Histopathology revealed a well differentiated squamous cell carcinoma arising from intestinal mucosa [Figure 2] and infiltrating through the full thickness of the small intestinal wall [Figure 3] with similar picture in the soft-tissue pieces. Retrospectively per speculum cervical examination was carried out, and Pap smears were studied to rule out malignancy. Pap smears showed atrophic smear pattern.
|Figure 2: Squamous cell carcinoma arising from the intestinal mucosa (H and E, ×100)|
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|Figure 3: Squamous cell carcinoma infiltrating in the wall (H and E, ×400)|
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| > Discussion|| |
The case presented with the similar symptoms of intestinal obstructions as in previous four cases. ,,,
Three of the previously reported cases were 65-year-old, two females and one male. The youngest one is 41-year-old female.  The present one is 59-year-old female. The present case is unusual in a way that though the primary tumor was in the small intestine, but it was in the form of an ulcer and not a growth protruding in the lumen. The infiltration of the tumor around the sigmoid causing strangulation, which was also reported in CT abdomen, lead to obstructive symptoms, which were relieved after the surgery. Female preponderance is distinct as four out of five cases were females and three of them were 65 years in age. The mechanism of developing squamous cell carcinoma here may be squamous metaplasia of glandular epithelium with subsequent malignant change. 
| > References|| |
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[Figure 1], [Figure 2], [Figure 3]