Mucinous Adenocarcinoma of the Colon in Uganda: A Case Report and Literature Review

Main Article Content

Richard Wismayer


Introduction: In Uganda, the Kampala Cancer Registry has reported a steady increase in the incidence of colorectal carcinoma(CRC) over the last few decades. The author reports a case of a 25 year old gentleman presenting with bowel obstruction and found to have mucinous adenocarcinoma of the colon. This is followed by a literature review of the clinical and pathological characteristics of young age sporadic colorectal carcinoma (YSCC) and hereditary nonpolyposis colorectal carcinoma (HNPCC).

Presentation of Case: This patient presented with a family history of colorectal carcinoma (CRC) and with bowel obstruction. An emergency laparotomy involving a right hemicolectomy was carried out. The postoperative course of this patient was uneventful.

Discussion: The typical histological features of mucinous adenocarcinoma of the colon were seen on the resected colon specimen. In addition this study reviews the literature regarding the clinical presentation, pathological characteristics, histology and prognosis of mucinous and medullary carcinoma of the colon.

Conclusions: Mucinous adenocarcinoma happens to be the most common histological type of colorectal carcinoma in young adults. In Uganda, low risk young patients with symptoms should be screened for colorectal lesions. A high index of suspicion should therefore be taken in the diagnosis of colorectal malignancy in these patients.

CRC, colorectal carcinoma, YSCC, young age sporadic colorectal carcinoma, HNPCC, hereditary non polyposis colorectal carcinoma, MSI, microsatellite instability.

Article Details

How to Cite
Wismayer, R. (2020). Mucinous Adenocarcinoma of the Colon in Uganda: A Case Report and Literature Review. Journal of Advances in Medicine and Medical Research, 32(9), 1-9.
Case Study


1. Arnold M, Sierra MS, Laversome M, Soerjomatoram I, Jemal A, Bray F. Global patterns and trends in colorectal carcinoma incidence and mortality. Gut. 2016;1-9.
2. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No: 2010.
3. Okobia MN. Cancer care in Sub-Saharan Africa – Urgent need for population-based cancer registries. The Ethiopian Journal of Health Development. 2003;17:89-98.
4. Parkin DM, Nambooze S, Wabwire-Mangen F, Wabinga HR. Changing Cancer incidence in Kampala, Uganda, 1991-2006. Int J Cancer. 2010;126(5):1187-95.
5. Forman D, Bray F, Brewster DH, Gombe Mbalwa C, Kohler B, Pineros M, Steliarova-Foucher E, Swaminathan R, Ferlay J. Cancer incidence in five continents. 2016;X:58-130.
6. Wabinga HR, Nambooze S, Amulen PM, Okello C, Mbus L, Parkin DM. Trends in the incidence of cancer in Kampala, Uganda 1991-2010. Int J. Cancer. 2014; 135(2):432-439.
7. Jass JR. Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology. 2007;50:113-30.
8. Alexander J, Watanabe T, Wu T, Rashid A, Li S, Hamilton SR. Histopathological identification of colon cancer with microsatellite instability. Am. J. Pathol. 2001;158(2):527-35.
9. Thirunavukarasu P, Sathaiah M, Singlas, Sukumar S, Karunamurthy A, Pragatheeshwar K, Lee K, Zah III H, Kane K and Bartlett D: Medullary carcinoma of the large intestine: A population based analysis. Int J Oncol. 2010;37:901-907.
10. Cunningham J, Kantekure K, Saif MW. Medullary carcinoma of the colon: A case series and review of the literature. 2014; 28:311-314.
11. Centre MM, Jemal A, Ward E. International trends in colorectal cancer incidence rates. Cancer Edpidemiology Biomarkers and Prevention. 2009;18(6):1688-1694.
12. De Kok MCM, Breda SGJ, Monson M. Mechanisms of combined action of different chemopreventive dietary compounds: A review. European Journal of Nutrition. 2008;47.2(S2): 51-9.
13. Dijxhoorn DW, Boutali A, Mulder CJ, Ssebuufu R, Mall A, Kalungi S, Baigrie C, Goldberg PA. Colorectal cancer in patients from Uganda: A histopathological study. East and Central African Journal of Surgery. 2014;19(1):112-119.
14. Lanza G, Gafa R, Matteuzzi M, Santini A. Medullary-type poorly differentiated adenocarcinoma of the large bowel: A distinct clinicopathologic entity characterised by microsatellite instability and improved survival. J. Clin Oncol. 1999;17:2429-2438.
15. Jessurun J, Romero-Guadarrama M, Manivel C. Medullary adenocarcinoma of the colon: clinicopathologic study of 11 cases. Hum. Pathol. 1999;30:843-848.
16. Calvert PM, Frucht H. The Genetics of colorectal cancer. Annals of Internal Medicine. 2002; 137(7):603-612.
17. Guttmacher AE, Collins FS, Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N. Eng. J. Med. 200303/06; 348(10):919-932.
18. Vasen HF, Mecklin JP, Khan PM, Lynch HT. The international collaborative group on hereditary non-polyposis colorectal cancer (ICG-HNPCC). Dis Colon Rectum. 1991;34(5):424-5.
19. Brassett C, Joyce JA, Froggatt NJ, Williams G, Furniss D, Walsh S, Miller R, Evans DG, Maher ER. Microsatellite instability in early onset and familial colorectal cancer. J. Med Genet. 1996; 33(12):981-985.
20. Dezois EJ, Boardman LA, Suwanthanma W, Limburg PJ, Cima R, Bakken JL, Vierkant RA, Aakre JA, Larzon DW. Young-onset colorectal cancer in patients with no known genetic predisposition: Can we increase early recognition and improve outcome? Medicine (Baltimore). 2008; 87(5):259-63.
21. De La Chapelle A, Hempel H. Clinical relevance of microsatellite instability in colorectal cancer. J. Clin Oncol. 2010; 28(20):3380-7.
22. Perucho M. Tumours with microsatellite instability: Many mutations, targets and paradoxes. Oncogene. 2003;22:2223-2225.
23. Kim NH, Jung YS, Yang HJ, Park SK, Park JH, Park DI, Sohn DI. Prevalence of and risk factors for colorectal neoplasia in asymptomatic young adults (20-39 years old). Clin. Gastroenterol. Hepatol. 2018; 1542-3565(18):30711.
24. Engeland VM, Weijenberg MP, Roemen GM, Brink M, De Bruine AP, Goldbohn AR, Brandt AP, Baylin S, De Goeij FPA, Herman JG. Effects of dietary folate and alcohol intake on promotor methylation in sporadic colorectal cancer: The Netherlands Cohort Study on Diet and Cancer. Cancer Research. 2003;15: 63(12).
25. Kondo J, Ekawa T, Endo H, Yamazaki K, Tanaka N, Kukita Y, Okuyama H, Okami J, Imamura F, Ohue M, Kato K, Namura T, Kohara A, Mori S, Dan S, Inoue M. High-throughout screening in colorectal cancer tissue-originated spheroids. Cancer Sci. 2019;110(1):345-355.
26. Rijnsoever VM, Grieu F, Elsaleh H. Characterisation of colorectal cancers showing hypermethylation at multiple CpG islands. Gut. 2002;51(6):797-802.
27. Ogino S, Cantor M. CpG island methylator phenotype (CIMP) of colorectal cancer is best characterised by quantitative DNA methylation analysis and prospective cohort studies. Gut. 2007;55(7):1000-6.
28. Hawkins N, Norrie M, Cheong K, Makong E, Ku SL, Meagher A, O’Connor T, Ward R. CpG island methylation in sporadic colorectal cancers and its relationship to microsatellite instability. Gastroenterology. 2002;122(5):1376-87.
29. Shan L, Toyota M, Kondo Y, Zhang EL, Guo Yi, Hernandez NS, Chen X, Ahmed S, Konishi K, Hamilton SR, Issa JP. Integrated Genetic and epigenetic analysis identifies three different subclasses of colon cancer. Prot. Natl. Acad. Sci. USA. 2007;104(47):18654-9.
30. Antequera F, Bird A. Number of CpG islands and genes in human and mouse. Proc. Natl. Acad Sci USA. 1993;90;11995-11999.
31. Toyota M, Ahuja N, Ohe Toyota M, Herman JG, Baylin SB, Issa JP. CpG island methylator phenotype in colorectal carcinoma. Proc Natl. Acad. Sci USA. 1999;96:8681-6.
32. Chiang JM, Hsieh PS, Chen JS, Tang R, You JF, Yeh CY. Rectal cancer level significantly affects rats and patterns of distant metastases among rectal cancer patients post curative-intent surgery without neoadjuvant therapy. World J. Surg. Oncol. 2014;12:197.
33. Winn B, Tavares R, Fanion J, Noble L, Gao J, Sabo E, Resnick MB. Differentiating the undifferentiated: Immunohistochemicak profile of medullary carcinoma of the colon with an emphasis on intestinal differentiation. Hum. Pathol. 2009;40(3):398-404.
34. Hill DA, Furman WL. Colorectal carcinoma in childhood and adolescence: A clinicopathologic review. J. Clin. Oncol. 2007;25(36):5808-5814.