Cetuximab combined with chemotherapy for simultaneous esophageal squamous cell carcinoma and colon adenocarcinoma:A case report

BACKGROUND Multiple primary carcinomas(MPCs)are defined as two or more independent primary cancers that occur simultaneously or sequentially in the same individual.Synchronous MPCs are rarer than solitary cancers or metachronous MPCs.Accurate diagnoses of synchronous MPCs and the choice of treatment are critical for successful outcomes in these cases.CASE SUMMARY A 64-year-old patient presented with dysphagia,without obvious cause.A diagnosis of synchronous esophageal squamous cell carcinoma and colon adenocarcinoma with liver metastasis was confirmed based on examination and laboratory results.After multi-disciplinary consultations,combination chemotherapy(a 3-wk cycle with oxaliplatin 212 mg administered on day 1 and capecitabine 1.5 g twice daily on days 1-14)and esophageal cancer radiotherapy were initiated.Based on the results of genetic testing,we switched to a regimen of leucovorin+fluorouracil+oxaliplatin and cetuximab regimen for 8 cycles.Subsequently,capecitabine and bevacizumab were administered until the most recent follow-up,at which the tumor remained stable.CONCLUSION Successful cetuximab chemotherapy treatment provides a reference for the nonoperative and homogeneous treatment of different pathological types of synchronous MCPs.

Three cancers in the renal pelvis,bladder,and colon:A case report

BACKGROUND Multiple primary cancers are rare occurrences that can involve either metachronous or synchronous development.It is particularly rare for an individual to have more than two primary cancers.In this report,we present a case study of an elderly man who was diagnosed with three heterochronous cancers in the renal pelvis,bladder,and colon.CASE SUMMARY On December 30,2014,a 51-year-old Chinese man was admitted to our hospital with complaints of intermittent painless gross hematuria for the preceding week.A computed tomography(CT)scan revealed wall thickening in the left ureter’s upper segment,while a CT urography revealed a left renal pelvis tumor.A successful laparoscopic radical resection of the left renal pelvis tumor was subsequently performed at Shanghai Zhongshan Hospital in January 2015.The pathological findings after the surgery revealed a low-grade papillary urothelial carcinoma of the renal pelvis.The final pathological tumor stage was pT1N0M0.After surgery,this patient received 6 cycles of intravenous chemotherapy with gemcitabine and carboplatin,as well as bladder infusion therapy with gemcitabine.On December 18,2017,the patient was admitted once again to our hospital with a one-day history of painless gross hematuria.A CT scan showed the presence of a space-occupying lesion on the posterior wall of bladder.Cystoscopic examination revealed multiple tumors in the bladder and right cutaneous ureterostomy was performed under general anesthesia on December 29,2017.The postoperative pathological findings disclosed multifocal papillary urothelial carcinoma of the bladder(maximum size 3.7 cm×2.6 cm).The bladder cancer was considered a metastasis of the renal pelvis cancer after surgery.The pathological tumor stage was pT1N0M1.The patient refused chemotherapy after surgery.After another six years,the patient returned on February 28,2023,complaining of periumbilical pain that had lasted six days.This time,a CT scan of the abdomen showed a tumor in the ascending colon,but a subsequent colonoscopy examination indicated a tumor in the descending colon.On March 12,2023,a subtotal colectomy and an ileosigmoidal anastomosis were carried out under general anesthesia.Postoperative pathological findings revealed that all three tumors were adenocarcinomas.The final pathological tumor stage was pT3N0M0.The patient had an uneventful postoperative recovery and was discharged without complications.CONCLUSION The case of this elderly man presents a rare occurrence of metachronous primary cancers in the renal pelvis and colon.Bladder cancer is considered a metastasis of renal pelvis cancer after surgery.Optimal treatment can be implemented by evaluating the patient’s histological features,clinical history,and tumor distribution correctly.

Rare synchronous colorectal carcinoma with three pathological subtypes: A case report and review of the literature

BACKGROUND Synchronous colorectal carcinomas(SCRC)are two or more primary colorectal carcinomas identified simultaneously or within 6 mo of the initial presentation in a single patient.Their incidence is low and the number of pathological types of SCRC is usually no more than two.It is very unusual that the pathological findings of a patient with SCRC show more than two different pathological subtypes.Here,we report a rare case of SCRC with three pathological subtypes.CASE SUMMARY A 75-year-old woman who had no previous medical history or family history was admitted to the hospital because of intermittent hematochezia for more than a month.Colonoscopy displayed an irregularly shaped neoplasm of the rectum,a tumor-like lesion causing intestinal stenosis in the descending colon,and a polypoidal neoplasm in the ileocecum.Subsequently,she underwent total colectomy,abdominoperineal resection for rectal cancer,and ileostomy.After operation,the pathological report showed three pathological subtypes including well-differentiated adenocarcinoma of the ascending colon,moderately differen-tiated adenocarcinoma of the descending colon,and mucinous adenocarcinoma of the rectum.She is now recovering well and continues to be closely monitored during follow-up.CONCLUSION Preoperative colonoscopy examination,imaging examination,and extensive intraoperative exploration play important roles in reducing the number of missed lesions.

Long-term survival of patients with hepatocellular carcinoma with hepatic,pulmonary,peritoneal and rare colon metastasis:A case report

BACKGROUND Hepatocellular carcinoma(HCC)is a highly malignant cancer that often metastasizes and has a poor prognosis.Gastrointestinal tract metastases are rare,and colon metastases are even rarer.The long-term survival of patients with multiple intrahepatic and extrahepatic metastases,especially to the colon,has not been previously reported.CASE SUMMARY We present an atypical clinical case of a patient with liver,right lung,peritoneal,and colon metastases diagnosed successively following hepatic resection for primary HCC.Comprehensive treatment,including partial liver,lung and colon resection,palliative management such as systemic chemotherapy,trans-arterial chemoembolization,targeted therapy with sorafenib,and cryotherapy were attempted.Despite his early metastases,the patient remained relatively healthy for 8 years after diagnosis.CONCLUSION This case indicates that comprehensive treatment is beneficial for certain patients with metastatic HCC.Clinicians should be alert as to the possibility of rare site metastatic tumors that may be easily misdiagnosed as primary tumors.

Disparities of conjugating protective enzyme activities in the colon of patients with adenomas and carcinomas

AIM:To investigate the metabolic enzymatic capacity of the colon mucosa to detoxify noxious carcinogenic compounds.METHODS:We investigated the activity of 2 conjugating enzymes-the microsomal uridine glucuronosyltransferase(UGT)and the cytosomal glutathione S-transferase(GST)in the uninvolved mucosa of the colon transversum and sigmoideum in patients with adenomatous polyps and colorectal cancer.Biopsies were taken from the mucosa during colonoscopies which were done for clinical(diagnostic)reasons.After storage,the biopsy material was homogenized and after differential centrifugation the enzyme assays were performed with 4-nitrophenol(UGT)and 1-chloro 2,4-dinitrobenzene(GST)as substrates.RESULTS:About 48 patients were included of which28 had adenomas and 20 had colorectal carcinomas confirmed by histopathology.Enzyme activities were expressed as nmol/mg per minute protein for the GST and as pmol/mg per minute protein for the UGT.Analysis of variance(F-test)indicated that both enzymes were more widely distributed in adenoma than in cancer patients.The means±SD were smaller for cancer patients:GST for adenomas 268±152 vs 241±69 for carcinomas and UGT for adenomas 197±200 vs 150±86 for carcinomas.CONCLUSION:Compared to patients with adenomatous colon polyps those with colorectal carcinoma exhibited a lower capacity of detoxifying enzyme metabolism and their activities clustered over a smaller range.

Effects of Meloxicam on Vascular Endothelial Growth Factor and Angiopoietin-2 Expression in Colon Carcinoma Cell Line HT-29

To investigate the effect of meloxicam, a selected NSAIDs, on cell growth, expression of VEGF and angiopointin-2 （Ang-2） protein in HT-29 cell line, cultured HT-29 cells were treated with meloxicam of various concentrations for various lengths of time. The proliferation of HT-29 was detected by cell counting kit-8 （CCK-8）, the cell cycle was determined by flow cytometer and the levels of VEGF and Ang-2 protein in supernatants were examined by enzyme linked immunosorbent assay （ELISA）. The mRNA expressions of VEGF and Ang-2 in cultured HT-29 were determined by real-time quantitative reverse-transcription polymerase chain reaction. Our results showed that treatment of meloxicam of different concentrations and for various lengths of time had a cytotoxicic effect on the cell proliferation of HT-29 cells in a concentration-dependant and time-dependant manner. Cell cycle analysis showed that the cells were mainly blocked in G0/G1 phase. The VEGF and Ang-2 protein levels in supernatants of the culture medium were decreased gradually in a concentration-dependent or time-dependent fashion. The mRNA expression of cox-2, VEGF and Ang-2 showed a gradual and concentration-dependent reduction. It is concluded that meloxicam can reduce the expression of VEGF and Ang-2 at the protein and mRNA level in colon carcinoma cell line.

Small-cell neuroendocrine carcinoma of the rectum—a rare tumor type with poor prognosis:A case report and review of literature

BACKGROUND Small-cell neuroendocrine carcinoma(SNEC)of the rectum is a rare tumor associated with poor prognosis.CASE SUMMARY We report a case of a 77-year-old male who came into our hospital because of blood with his stool.An endoscopy revealed a cauliflower-like neoplasm in his rectum.Imaging examination showed that the lesion in the upper rectum was likely rectal cancer,and there was no evidence of metastasis.The patient was treated with surgery.Pathological examination confirmed SNEC of the rectum and an R0 resection was achieved.However,1 mo after the operation,the patient developed intestinal and ureteral obstructions due to peritoneal metastases.Finally,the patient died from renal failure.CONCLUSION SNEC of the rectum is a high-grade carcinoma with an aggressive phenotype,and surgery should be cautiously considered.

Mucinous cystadenoma of the appendix associated with adenocarcinoma of the sigmoid colon and hepatocellular carcinoma of the liver:Report of a case

附录的粘蛋白的包囊腺瘤是一个稀罕条件并且与附录的普通名字粘液囊肿代表三个实体之一。它被腔的膀胱的膨胀在它内与粘液的壅滞描绘。组织病理学说地，粘液囊肿被划分成三个组：焦点或弥漫的粘膜增生，粘蛋白的包囊腺瘤和粘蛋白的包囊腺癌。这个条件经常与另外的瘤形成被联系，特别冒号和卵巢的腺癌。我们这里描述与腹的不快，便秘，在凳子的新鲜的血和经常的泌尿介绍了的 57 岁男性病人。他有与结肠的腺癌和肝的肝细胞癌联系的附录的一个大包囊腺瘤。病人经历了正确 haemicolectomy， S 字形的冒号切除术和肝的部分切除术。现在， 3 年以后，他没有疾病恶化的证据。根据这，我们在这些病人强调精确外科手术前的诊断的需要和整个腹部的 intraoperative 探索。

Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess:A case report and review of the literature

This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A 54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure,which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy,with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure,and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma,synchronous isolated splenic metastasis and concomitant splenic abscess. This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected,careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless,no definitive conclusions can be drawn because of the small number of cases.

Clear cell adenocarcinoma of the colon:A case report and review of literature

A primary clear cell adenocarcinoma of the colon is a rare oncologic entity. We herein report a case of such a tumor of the sigmoid colon in a 71-year-old woman who was successfully treated by an endoscopic polypectomy in our hospital. We also reviewed the published reports regarding cases of primary clear cell tumors in the colon.

Avidin-biotin system pretargeting radioimmunoimaging and radioimmunotherapy and its application in mouse model of human colon carcinoma

AIM: To evaluate the multi-step pretargeting radioimmunoimaging (RII) and radioimmunotherapy (RIT) in nude mice bearing human colon carcinoma with avidin-biotin system labeled with 153Sm.METHODS: Two- and three-step strategies for avidinbiotin system pretargeting techniques were established.In a three-step procedure, human colon carcinoma bearing nude mice were first injected with biotinylated monoclonal antibody (McAb-Bt) followed by cold avidin (Av) 48 h later and then 153Sm-DB2 24 h thereafter;whereas the twostep procedure consisted of injection of 153Sm-SA 48 h after pretargeting with biotinylated anti-CEA monoclonal antibody (CEA McAb-Bt). SPECT imaging and biodistribution were performed at 4, 24, 48, or 72 h after injection of 153Sm-labeled compounds. Five groups of nude mice subcutaneously grafted with human colon carcinoma were treated 3 d after grafting. One group received the injection with 100 μg CEA McAb-Bt followed by cold avidin (80 μg)after 2 d and 11.1 MBq 153Sm-DB2 after 1d. Four control groups were treated respectively with 11.1 MBq 153SmCEA McAb, 11.1 MBq 153Sm-nmIgG, 11.1 MBq 153Sm-DB2,100 Μl normal saline. Toxicity was evaluated by changes of leukocyte count, and the efficacy by variation in tumor volume. Histological analyses of tumors were performed.RESULTS: The three-step procedure allowed faster blood clearance and yielded higher tumor blood ratios (5.76 at4 h and 12.94 at 24 h) of the 153Sm-DB2. The tumor was clearly visualized at 4 h in y-imaging after the injection of 153Sm-DB2, while a significant accumulation of 153Sm-SA in the tumor was observed only 24 h after the injection and tumor blood ratios at 4 and 24 h were 1.00 and 2.03,respectively, in the two-step procedure. Pretargeting RIT and 153Sm-CEA McAb had a strong tumor-inhibiting effect.The tumor inhibitory rate was 80.67% and 78.44%,respectively, five weeks after therapy. Histopathological evidence also indicated radioactive damage in tumor tissues as necrosis of tumor cells, while in the other organs such as liver and kidney no radioactive damage was observed. Leukocyte counts showed significant decrease after treatment in groups of 153Sm-CEA Mc Ab and 153SmnmIgG.CONCLUSION: The two kinds of pretargeting strategies can elevate the target-to-nontarget ratio, decrease the blood background and shorten the imaging time compared to 153Sm-CEA McAb. Three-step pretargeting RIT is as efficient as 153Sm-CEA Mc Ab, but markedly less toxic. This study provides experimental evidence for the clinical application of pretargeting RII and RIT.

Colonic metastasis after resection of primary squamous cell carcinoma of the lung:A case report and literature review

Lung cancer is a common malignancy in the world;however symptomatic colonic metastasis from primary lung cancer is rare.A 64-year-old man was originally found poorly differentiated squamous cell carcinoma of right lung and received right lower lobectomy and lymph node dissection.Three years later,the patient presented to our emergency room with the symptom of upper abdominal pain and weight loss.Abdominal palpation and computed tomography scan of the abdomen revealed a large mass measuring 7.6 cm×8.5 cm in the ascending colon.Colonoscopy and biopsy revealed poorly differentiated squamous cell carcinoma with similar morphological pattern to that of the previous lung cancer.Chemotherapy was given and the patient died 5mo later.Lung cancer metastatic to the colon confers a poor prognosis:overall survival ranged from 5 wk to 1year,with a median survival of 3 mo after the diagnosis of the colonic metastasis.

Successful treatment of basaloid squamous cell carcinoma in the rectosigmoid colon: A case report and review of literature

BACKGROUND Compared with colorectal adenocarcinoma,basaloid squamous cell carcinomas(BSCCs)arising in the colorectum are rare and have very poor prognosis.To date,only nine cases have been reported.Most BSCCs are extensively involved in metastasis to the lymph node,liver,and lung at diagnosis.Despite many clinicians attempting to effectively treat BSCCs,therapeutic consensus has not been established due to lack of information.CASE SUMMARY A 58-year-old woman presented with abdominal pain,diarrhea,fever,and hematochezia.She was referred from a department of gynecology and was diagnosed with a suspicious leiomyosarcoma of the rectum or a pedunculated myoma of the uterus.An exophytic growing mass at the right lateral wall of the rectum with an internal cystic portion and hemorrhage was observed on magnetic resonance imaging.The patient underwent low anterior resection and total hysterectomy with bilateral salphingo-oophorectomy.Histopathological findings revealed a cellular mass with a solid growth pattern and few glandular structures,many foci of intratumoral necrosis,and a palisading pattern.The pathologist diagnosed tumor as a BSCC,and the patient received chemotherapy with fluorouracil/leucovorin without radiotherapy.The patient is currently alive 8 years after the surgery with no manifestations of metastatic colon cancer.CONCLUSION Our case suggest that curative resection and chemotherapy play important roles in improving survival,and radiotherapy may be an option to avoid radiationassociated enteritis.

Structural and functional aspects of the liver and liver sinusoidal cells in relation to colon carcinoma metastasis

Nowadays, liver metastasis remains difficult to cure. When tumor cells escape and arrive in the liver sinusoids, they encounter the local defense mechanism specific to the liver. The sinusoidal cells have been widely described in physiologic conditions and in relation to metastasis during the past 30 years. This paper provides an 'overview' of how these cells function in health and in diseases such as liver metastasis.

Retrospective Studies on Clinical Features of Melanosis of the Colon and Its Correlation with the Polypus and Carcinoma of Large Intestine

OBJECTIVE To investigate the clinical characteristics ofmelanosis of the colon (MC) and its correlation with polypus andcarcinoma of the large intestine.METHODS Clinical feature and colonoscopic findings of 156MC patients were retrospectively analyzed. Final diagnosis of MCcase was made after colonoscopic and pathological examination,and data of the case history was recorded.RESULTS The overall detection rate of MC was 1.12%, with0.46% in males, 0.66% in females. An 82.69% of the patientssuffered various constipations and had a history of takingcathartics. The clinical manifestation of total-colon melanosisoccurred in 83.97% of the patients. There was no significantdifference between the rate of concomitant polypus (27.56%) inthe MC patients and the detection rate of polypus in the patientswho underwent a synchronous colonoscopy (x^2 = 1.205, P = 0.298).Also there was no significant difference between the detectionrate of carcinoma of the large intestine (8.97%) in MC patientsand the detection rate of the same disease in the patients whounderwent synchronous colonoscopy (x^2 = 0.268, P = 0.604). Alogistic regression analysis has shown that the older the age of MCpatients is, the more opportunities of MC and the concomitantpolypus would occur.CONCLUSION MC may be related to constipations and along-term administration of cathartics, among which total-colonmelanosis ranks first in the cases. There is an earlier age of onsetin the females, with a higher detection rate. The older the age ofthe patients is, the higher the detection rate of MC is, and the morepossibility the onset of the concomitant polypus.

Synergistic Action of fMLP-boanmycin Combination on the Growth of Mouse Colon Carcinoma and Its Action Mechanisms

Objective： The inhibitory action of fMLP-boanmycin （BAM） combination on the growth of mouse colon carcinoma and its action mechanisms were observed in order to provide experimental proof for probing novel regimen of chemotactic modulation in combination with chemotherapy in the treatment of cancer. Methods： Cytotoxicity of BAM-fMLP combination to tumor cells was determined by MTT assay in vitro. Antitumor activity of BAM-fMLP combination was assessed in mice subcutaneously transplanted colon carcinoma 26. The amount of superoxide anion （O2 ·^-）released from fMLP stimulated macrophages was determined by NBT assay. The amount of nitric oxide （NO） was indirectly determined by Griess method. Results： BAM-fMLP combination had no synergistic effect on tumor cells（CDI〉0.85）, but BAM at the doses of 10μg/ml, 30μg/ml and 100μg/ml in combination with fMLP at the concentration 20μg / ml exhibited synergistic effect on tumor cells in the presence of macrophages（CDI〈0.75）, fMLP inhibited the growth of colon carcinoma 26 by 50.0% when it at dose of 1 mg/mouse was administered peritumorally. BAM （1 mg/kg, intraperitoneally, three times） alone and BAM - fMLP combination inhibited the growth of colon carcinoma 26 by 38.6% and 78.4%, respectively （CDI=0.71） on day 12. The amount of O2 ·^- released from fMLP 4.6×10^-7 mol/L （0.2μg/ml） stimulated macrophages which were treated by BAM in vitro increased significantly（P〈0.01）, fMLP 2.3×10^-6 mol/L （1μg/ml） could not stimulate macrophages to release NO, but may stimulate macrophages treated with BAM 10μg/ml and 100μg/ml to release NO significantly（P〈0.01）. Conclusion： The inhibitory action of fMLP-boanmycin combination on the growth of mouse colon carcinoma have synergism, which may associate with the increase of O2 ·^- and NO released by macrophages. Chemotactic modulation in combination with chemotherapy may be a novel regimen in the treatment of cancer.

Collision carcinoma of the rectum involving neuroendocrine carcinoma and adenocarcinoma:A case report

BACKGROUND Collision carcinoma is a rare histological pattern,and includes two or more different types of tumors coexisting in the same organ as one neoplasm.Different to the combined type,the two adjacent tumors of collision carcinoma are histologically distinct.Collision carcinoma may occur from any origin or organ,including the cecum,liver,cervix,thyroid,stomach,kidney,and esophagus.In the rectum,adenocarcinoma is the most common pathological type,the combined type is rare,and collision tumors are even rarer.To date,only a limited number of collision carcinoma cases originating from the rectum have been reported.Due to the scarcity of rectal collision carcinoma,more cases need to be reported to fully understand the clinico-pathological features and biological behavior of the tumor.CASE SUMMARY Here we report a 40-year-old female who presented with the chief complaints of persistent changes in bowel habits and hematochezia for 10 d.She underwent Miles'operation which revealed a collision carcinoma of the rectum,showing a“side by side”pattern,composed of a high grade neuroendocrine carcinoma,(small cell carcinoma)and moderately differentiated adenocarcinoma,based on its clinico-pathological features and biological behavior.The patient remained disease-free at 12 mo follow-up.We also focused on the related literature and expert opinion.CONCLUSION Collision carcinoma is a rare tumor with ambiguous biological behavior.Greater attention should be paid to its clinico-pathologic diagnosis.Regular and adequate follow-up is essential to help rule out metastasis and assess the prognosis.

The Effect of Survivin siRNA on Apoptosis, Proliferation and Invasion by a Colon Carcinoma Cell Line

OBJECTIVE To study the efficiency of silencing survivin gene expression by an anti-survivin small RNA expression plasmid and to examine its impact on apoptosis, proliferation and invasive ability of the SW480 colorec-tal cancer cell line. METHODS An expression plasmid of survivin siRNA (pRNAT/sur-siR-NA) was constructed and transduced into SW480 cells. Western blot analysis and a semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) were used to measure the change in expression level of the survivin protein and mRNA after transduction of the expression plasmid into the SW480. Apoptosis, proliferation, and invasive ability of the SW480 cells was evaluated by flow cytometry, MTT assay and Boy-den Chamber Assay, respectively. RESULTS The expression plasmid (pRNAT/sur-siRNA) against survivin down-regulated survivin protein and mRNA expression dramatically, with a down-regulation of 85% and 80%, respectively. After transfection of the pRNAT/sur-siRNA to the SW480 cells, the apoptotic rate of the pRNAT/ sur-siRNA/SW480 cells was 16.9%, and the proliferation rate was 37.4%, significantly different compared to the controls (P<0.01). Cell invasive studies (Boyden Chamber Assay) showed that number of cells penetrating the membrane for the pRNAT/sur-siRNA/SW480, pRNAT/SW480 and the SW480 cells was 153±66, 505±65 and 578±98, respectively (P<0.01). CONCLUSION siRNA against survivin can significantly inhibit the expression of survivin in SW480 cells, and thus promote apoptosis, inhibit proliferation and invasive ability.

Colon signet-ring cell carcinoma with chylous ascites caused by immunosuppressants following liver transplantation:A case report

BACKGROUND Chylous ascites is caused by disruption of the lymphatic system,which is characterized by the accumulation of a turbid fluid containing high levels of triglycerides within the abdominal cavity.The two most common causes are cirrhosis and tuberculosis,and colon signer ring cell carcinoma(SRCC)due to the use of immunosuppressants is extremely rare in cirrhotic patients after liver transplantation,making it prone to misdiagnosis and missed diagnosis.CASE SUMMARY A 52-year-old man who underwent liver transplantation and was administered with immunosuppressants for 8 months was admitted with a 3-month history of progressive abdominal distention.Initially,based on lymphoscintigraphy and lymphangiography,lymphatic obstruction was considered,and cystellar chyli decompression with band lysis and external membrane stripping of the lymphatic duct was performed.However,his abdominal distention was persistent without resolution.Abdominal paracentesis revealed allogenic cells in the ascites,and immunohistochemistry analysis revealed adenocarcinoma cells with phenotypic features suggestive of a gastrointestinal origin.Gastrointestinal endoscopy was performed,and biopsy showed atypical signet ring cells in the ileocecal valve.The patient eventually died after a three-month follow-up due to progression of the tumor.CONCLUSION Colon SRCC,caused by immunosuppressants,is an unusual but un-neglected cause of chylous ascites.