anorectal stenosis, constipation at a young age [Video]

#anorectal stenosis
#constipation at a young age
#colorectal cancer at a young age
A 29-year-old woman presented with difficulty defecation and weight loss and was admitted to the endoscopy unit. The patient underwent a colonoscopy. The scope revealed stenosis at the anorectal region with tubular lumen and difficulty proceeding with the scope. Multiple biopsies(1.2 x 1.2 cm) were taken, but the anorectal mucosa is gritty and brutal during biopsies. The histopathology was inconclusive for malignancy, but the colonoscopic appearance favored malignancy. Oncologic consultation advice for other biopsies and rebiopsies, so another colonoscopy was done with biopsies. Both biopsies were sent to another #pathologist. The recent report revealed dysplasia and some mucinous cells but, again, inconclusive for malignancy. The endoscopist insists on his opinion on the presence of malignancy, so he advises immunohistochemistry. The immunostaining was 100% positive for cytokeratin, so adenocarcinoma was diagnosed.