A rare case of synchronous gastrointestinal malignancy- a case report

Introduction Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is a autosomal dominant syndrome characterized by early age onset neoplastic lesions of colon, andmicrosatellite instability (MSI). HNPCC accounts for 2-10 of all the colorectal cancer cases1, commonly involving left sided or distal colon2, but in our case right side of the colon was involved. We present one such case with involvement of stomach and colon together. Case A 46 year old male presented with large bowel type diarrhea, pain abdomen , weight loss and appetite loss with a significant family history of colon malignancy among 2 first degree relatives. On investigating, blood investigations were normal except for anemia. Colonoscopy and gastroscopy revealed , multiple colonic polyposis(15-20) with circumferential proliferative growth at ascending colon and ulceroproliferative growth at antrum respectively. Histopathology examinations of colonic antral growth showed moderately differentiated adenocarcinoma and poorly differentiated adenocarcinoma respectively. so with 2 first degree relatives with colon cancer and the patient diagnosed with gastric colon cancer, he satisfies the Amsterdam criteria for HNPCC. Hence tested for MSI for confirmation which came positive for MLH1 and MSH2. CECT abdomen was done for staging the disease and staged as T3N0M0. So curative surgery was done in a single attempt with a successful recovery.