Saigopal R. Gujjula, MD1, Ali Wakil, MD2, Chaula Desai, MD1, Manasa Ginjupalli, MD1, Suriya Baskar, MD1, Sweta Lohani, MD1, Iyad Al-Bustami, MD, MPH3, Hamsika Moparty, MD4, Ying Xian Liu, MD1, Mohammad Nawaz, MD5 1Brooklyn Hospital Center, Brooklyn, NY; 2One Brooklyn Health-Interfaith Medical Center, Brooklyn, NY; 3University of Texas Health, McGovern Medical School, Houston, TX; 4Rutgers New Jersey Medical School, Brooklyn, NY; 5The Brooklyn Hospital Center, Brooklyn, NY Introduction: Rectal squamous cell carcinoma (RSCC) is a rare type of rectal cancer with an estimated incidence of 0.10 to 0.25 per 1000 colorectal cancers1. Squamous cell carcinoma usually affects the anal canal due to presence of columnar, stratified columnar and stratified squamous cells when rectal histology is primarily composed of simple columnar epithelial cells driving the common incidence of rectal adenocarcinoma2. In this article we describe a rare case of RSCC.
Case Description/
Methods: A 75-year-old female with a past medical history of hypertension, Alzheimer’s dementia, peripheral artery disease, hypercholesterolemia, Vitamin B12 and Vitamin D deficiency presented to the clinic for surveillance colonoscopy with a prior history of a 10mm hyperplastic transverse colon polyp that was removed. On this visit, the patient reports a twenty-pound weight loss in the past year. She denies any family history of gastrointestinal malignancies or high-risk polyps. Patient was hemodynamically stable with an unremarkable physical exam. Labs show a Hemoglobin: 11.9 g/dl, Hematocrit: 36%, WBC: 5.1 U/L, Platelets: 229000 U/L, Iron: 131, TIBC: 300 MCG/DL, Ferritin: 25 NG/ML, CEA: 2.1 NG/ML/L, HIV negative. Colonoscopy showed a 4mm sessile polyp in the rectum which was removed by a cold snare. Pathology results of rectal biopsy showed neoplastic cells with fragments of squamous cell carcinoma, with basaloid features (Figure 2). Positive for P40, P63, P16, CKpan, CK7, AE1/3 with about 70% Ki-67 and high-risk HPV. Negative for CD56, chromogranin, synaptophysin, CK20 and CDX2. She then underwent Endoscopic Ultrasound revealing pT1 N0 M0 stage. Therefore she underwent endoscopic mucosal resection of a 1cm lesion with slightly depressed center and elevated margins along the proximal anal verge, negative margins. The patient completed chemoradiation, with present remission status. Discussion: Rarity of RSCC makes providing a definite treatment plan challenging. Cancerous rectal masses are commonly deemed to be adenocarcinoma. Staged using TNM criteria, treatment options commonly include chemoradiation using 5 fluorouracil and mitomycin c, endoscopic mucosal resection / dissection relative to stage and management of HPV infection3. However, criteria for selection has yet to be established in literature due to RSCC’s infrequent occurrence4. The histological pattern of the rectum makes the differential of RSCC unanticipated for however it should be taken into consideration as it can be easily missed on routine colonoscopy.
Figure: Figure 1: A 4 mm rectal polyp A) found on retroflexion view of the rectum. B) The rectal polyp was removed using a cold snare polypectomy
Figure: Figure 2: Pathology H&E stain of the rectal polyp showing neoplastic cells with fragments of squamous cell carcinoma, with basaloid features
Disclosures: Saigopal Gujjula indicated no relevant financial relationships. Ali Wakil indicated no relevant financial relationships. Chaula Desai indicated no relevant financial relationships. Manasa Ginjupalli indicated no relevant financial relationships. Suriya Baskar indicated no relevant financial relationships. Sweta Lohani indicated no relevant financial relationships. Iyad Al-Bustami indicated no relevant financial relationships. Hamsika Moparty indicated no relevant financial relationships. Ying Xian Liu indicated no relevant financial relationships. Mohammad Nawaz indicated no relevant financial relationships.
Saigopal R. Gujjula, MD1, Ali Wakil, MD2, Chaula Desai, MD1, Manasa Ginjupalli, MD1, Suriya Baskar, MD1, Sweta Lohani, MD1, Iyad Al-Bustami, MD, MPH3, Hamsika Moparty, MD4, Ying Xian Liu, MD1, Mohammad Nawaz, MD5. P4817 - Rectal Squamous Cell Carcinoma: A Rare Case of Malignant Small Polyp, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
