SHM Converge Scientific Abstract ePoster Gallery-An Unexpected Site for Small Cell Carcinoma and Inpatient Management

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A 52-year-old man with HIV on antiretroviral therapy, ulcerative colitis, and untreated hepatitis C presented with several weeks of constipation, tenesmus, and rectal pain that initially had been attributed to hemorrhoids. On admission he was febrile and tachycardic. CT imaging of the abdomen revealed a large rectal mass with suspicious liver and lung lesions consistent with metastatic disease. Colonoscopy showed a fungating, infiltrative, ulcerated, partially obstructing 5 cm rectal mass. Biopsy demonstrated necrotic, poorly differentiated carcinoma consistent with a high-grade neuroendocrine tumor, with a Ki-67 index of 90%.<br /><br />After discharge with oncology follow-up, he returned to another institution with worsening rectal and abdominal pain, lethargy, and malaise. An inpatient ultrasound-guided liver biopsy confirmed small cell carcinoma. During this admission, medical and radiation oncology were consulted and he received palliative radiation to the rectal mass and initial chemotherapy with carboplatin and etoposide. Surgical oncology recommended deferring surgery until after chemoradiation. He was discharged with preserved functional status and plans for ongoing outpatient chemotherapy and possible immunotherapy.<br /><br />The report emphasizes that colorectal small cell carcinoma is an exceptionally rare and aggressive malignancy with a poor prognosis. It also highlights emerging interest in immunotherapy combined with platinum-based chemotherapy. Because evidence is limited, important questions remain about the value of initiating treatment inpatient and the optimal roles of surgery and radiation. The case also illustrates the importance of hospitalists in coordinating care for medically complex, immunocompromised patients undergoing cancer treatment.

Asset Subtitle

Bryan Chan

Meta Tag

Author List Achraf Mansour, Amish Parikh, Bryan Chan, Tina Wang

Category Clinical Vignettes

Concept Colorectal Small Cell Carcinoma

Concept Metastasis

Concept Prognosis

Concept Platinum-Based Chemotherapy

Concept Colonoscopy

Distinguished Non-Finalist

Presenter Organization Huntington Health

Presenting Author Bryan Chan

Track Adult

Keywords

colorectal small cell carcinoma

high-grade neuroendocrine tumor

rectal mass

metastatic disease

HIV

ulcerative colitis

carboplatin and etoposide

palliative radiation

immunotherapy

hospitalist care

Colorectal Small Cell Carcinoma

Metastasis

Prognosis

Platinum-Based Chemotherapy

Colonoscopy