Abstract
BACKGROUND: Digestive adenocarcinoma is rare in the pediatric population with only a few case reports in the literature. AIMS: We describe 2 pediatric patients with digestive adenocarcinoma, one in the colon and the other in the stomach, diagnosed in St Justine University Hospital Center in 2018. METHODS: Case 1: A fourteen-year-old girl presented with severe abdominal pain. She had a 3-month history of diarrhea, rectal bleeding and weight-loss. She had a morbid obesity with a BMI at 41.8 kg/m(2). There was no family history of malignancy. Colonoscopy revealed an exophytic, friable and hemorrhagic mass at the recto sigmoidal junction. Histopathology showed an infiltrating poorly differentiated adenocarcinoma with p53 mutation. Chemotherapy was initiated. One month later, repeat work-up showed progression of the recto-sigmoidal mass with stenosis of the colic lumen, as well as a new stenotic zone upstream. There was also progression of the peritoneal carcinomatosis. The clinical course was marked by pulmonary embolism and repeated intestinal occlusive episodes. Case 2: A 13-year-old boy presented with a 3 week history of severe epigastric pain, hematemesis, breathlessness and asthenia. He reported a 6-month history of dysphagia, anorexia, nausea and a 5 kg weight loss. Family’s medical history revealed a paternal grandfather with colon cancer and a cousin with sarcoma. Gastroscopy showed a mass at the gastroesophageal junction. Histopathology showed a moderately differentiated high-grade adenocarcinoma with p53 gene mutation. Despite 2 months of chemotherapy, there was no regression of the lesions and the patient required nasogastric feedings. He also had deep vein thrombosis. RESULTS: In those 2 pediatric cases, the digestive symptoms were non-specific. Tumors were visible at endoscopy and biopsy could be performed. At the time of diagnosis, adenocarcinomas were already metastatic and carried a poor prognosis. Both patients had high serum levels of Carcinoembryonic Antigen (CEA), respectively 706.9 and 864.7 μg/L. CONCLUSIONS: Adenocarcinomas are extremely rare in children. They are generally aggressive and have a poor prognosis. Pediatric gastroenterologists must consider this entity in their differential diagnosis of digestive symptoms. A rigorous and comprehensive approach must be taken. The CEA blood test is useful for detecting recurrent colorectal cancer but would not be useful as a screening tool in the pediatric population. FUNDING AGENCIES: None