Abstract
BACKGROUND: Squamous cell carcinoma (SCC) of the colon is a rare malignant tumor with an unclear pathogenesis. Its clinical presentation is similar to that of adenocarcinoma, and there are no standard treatment guidelines. Treatment for SCC of the colon is mainly based on the protocols for colon adenocarcinoma. In advanced stages, colon SCC is highly invasive, prone to distant metastasis, and has a worse prognosis than adenocarcinoma. Furthermore, pancreatic metastasis from colon SCC is even rarer. CASE SUMMARY: The patient presented with abdominal pain and was diagnosed with SCC of the descending colon following colonoscopy. Preoperative examinations did not reveal any obvious metastasis to other organs, and the patient underwent laparoscopic radical resection of the descending colon cancer. During surgery, suspicious metastases to the pancreatic body and tail, splenic vessels, and splenic hilum were found, leading to combined resection of the pancreatic body and tail along with the spleen. Postoperative pathology confirmed moderately to poorly differentiated SCC with nerve invasion. The patient developed postoperative complications, including abdominal cavity infection, acute myocardial infarction, and deep vein thrombosis in the lower limbs. Despite active symptomatic treatment and stabilization of the patient's vital signs, the patient did not undergo adjuvant chemotherapy due to an Eastern Cooperative Oncology Group score of 3. The patient passed away 3 months postoperatively due to multiple organ failure. CONCLUSION: This case highlights the aggressive nature of colorectal SCC with atypical metastasis and underscores the necessity for multidisciplinary perioperative management.