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Rectorrhagia in A Young Patient as a Manifestation of Lynch Syndrome. Case report
PDF Reporte de Caso (Spanish)

Keywords

Polyps
Cancer
Hereditary
Case report
Colon

Categories

How to Cite

1.
Rectorrhagia in A Young Patient as a Manifestation of Lynch Syndrome. Case report. Rev Med Clin [Internet]. 2025 Mar. 5 [cited 2025 Jul. 6];9(1):e05032509004. Available from: https://mail.medicinaclinica.org/index.php/rmc/article/view/624

Abstract

Lynch syndrome (LS), also known as hereditary nonpolyposis colorectal cancer (HNPCC), is considered the most common type of hereditary colon cancer with autosomal dominant inheritance. It has been reported to have an 80% risk of developing colorectal cancer, 60% risk of endometrial cancer, and, depending on the variant, increased risk of other primary cancers such as gastric, ovarian, urothelial, biliary tract, cerebral, small intestine, cutaneous, pancreatic. The identification of carriers of pathogenic mutations in MMR genes (MLH1, MSH2, MSH6, PMS2) is important for the timely detection of SL-associated cancers. The Amsterdam II criteria should be implemented, which identifies patients with a high suspicion of LS, to complement it with genetic studies, including microsatellite instability, to perform timely detection, and to be able to reduce complications and mortality. We present the case of a male patient with a family history of colon, endometrial and ovarian cancer in his first- and second-degree family, respectively, with three months of evolution of iron deficiency anemia and exacerbated rectorrhagia, where, after endoscopic studies, histopathological study reports moderately differentiated adenocarcinoma of the colon with high detection of microsatellite instability, genetic studies are extended with diagnosis of Lynch Syndrome., and it is decided to start FOLFOX chemotherapy for neoadjuvant treatment. Lynch syndrome is an atypical pathology with a low presentation rate, which contributes to the medical literature to reinforce the importance of family history and genetics in order to expand knowledge about the heterogeneity of LS, helping to optimize screening, diagnostic and treatment strategies.

PDF Reporte de Caso (Spanish)

References

Bonadona, V., Bonaïti, B., Olschwang, S., Grandjouan, S., Huiart, L., Longy, M., Guimbaud, R., Buecher, B., Bignon, Y. J., Caron, O., Colas, C., Noguès, C., Lejeune-Dumoulin, S., Olivier-Faivre, L., Polycarpe-Osaer, F., Nguyen, T. D., Desseigne, F., Saurin, J. C., Berthet, P., … Bonaïti-Pellié, C. (2011). Cancer risks associated with germline mutations in MLH1, MSH2, and MSH6 genes in lynch syndrome. JAMA, 305(22). https://doi.org/10.1001/jama.2011.743

Castro-Mujica, M. D. C., & Barletta-Carrillo, C. (2018). Síndrome de Lynch: aspectos genéticos, clínicos y diagnósticos. Revista de Gastroenterologia Del Peru: Organo Ofici al de La Sociedad de Gastroenterologia Del Peru, 38(3). https://doi.org/10.47892/rgp.2018.383.913

Moreira, L., Balaguer, F., Lindor, N., De La Chapelle, A., Hampel, H., Aaltonen, L. A., Hopper, J. L., Le Marchand, L., Gallinger, S., Newcomb, P. A., Haile, R., Thibodeau, S. N., Gunawardena, S., Jenkins, M. A., Buchanan, D. D., Potter, J. D., Baron, J. A., Ahnen, D. J., Moreno, V., … Castells, A. (2012). Identification of Lynch syndrome among patients with colorectal cancer. JAMA, 308(15). https://doi.org/10.1001/jama.2012.13088

Pearlman, R., Frankel, W. L., Swanson, B., Zhao, W., Yilmaz, A., Miller, K., Bacher, J., Bigley, C., Nelsen, L., Goodfellow, P. J., Goldberg, R. M., Paskett, E., Shields, P. G., Freudenheim, J. L., Stanich, P. P., Lattimer, I., Arnold, M., Liyanarachchi, S., Kalady, M., … Hampel, H. (2017). Prevalence and spectrum of germline cancer susceptibility gene mutations among patients with early-onset colorectal cancer. JAMA Oncology, 3(4). https://doi.org/10.1001/jamaoncol.2016.5194

ten Broeke, S. W., van der Klift, H. M., Tops, C. M., Aretz, S., Bernstein, I., Buchanan, D. D., de la Chapelle, A., Capella, G., Clendenning, M., Engel, C., Gallinger, S., Gomez Garcia, E., Figueiredo, J. C., Haile, R., Hampel, H. L., van Hest, L., Hopper, J. L., Hoogerbrugge, N., von Knebel Doeberitz, M., … Ko Win, A. (2018). JOURNAL OF CLINICAL ONCOLOGY Cancer Risks for PMS2-Associated Lynch Syndrome. J Clin Oncol, 36. DOI: 10.1200/JCO.2018.78.4777

Hitchins, M. P. (2013). The role of epigenetics in Lynch syndrome. Familial Cancer, 12(2). https://doi.org/10.1007/s10689-013-9613-3

Leclerc, J., Vermaut, C., & Buisine, M. P. (2021). Diagnosis of lynch syndrome and strategies to distinguish lynch-related tumors from sporadic MSI/DMMR tumors. In Cancers (Vol. 13, Issue 3). https://doi.org/10.3390/cancers13030467

Snowsill, T., Coelho, H., Huxley, N., Jones-Hughes, T., Briscoe, S., Frayling, I. M., & Hyde, C. (2017). Molecular testing for Lynch syndrome in people with colorectal cancer: Systematic reviews and economic evaluation. Health Technology Assessment, 21(51). https://doi.org/10.3310/hta21510

Georgiou, D., Monje-Garcia, L., Miles, T., Monahan, K., & Ryan, N. A. J. (2023). A Focused Clinical Review of Lynch Syndrome. In Cancer Management and Research (Vol. 15). https://doi.org/10.2147/CMAR.S283668

Carrera Chinizaca VM, Arroyo Valencia VT, Insuasti Arcos NM, Vásquez de la Bandera Gonzenbach PD. Síndrome de Lynch. RECIAMUC. 2021 Sep 2;5(3):123–31. https://doi.org/10.26820/reciamuc/5.(3).agosto.2021.123-131

Ferrer Márquez M, Reina Duarte Á, Maturana Ibáñez V, Belda Lozano R, Rubio Gil F, Blesa Sierra I, et al. Síndrome de Lynch: Genética y cirugía. Vol. 89, Cirugia Espanola. 2011. DOI: 10.1016/j.ciresp.2010.06.010

Peltomäki P, Nyström M, Mecklin JP, Seppälä TT. Lynch Syndrome Genetics and Clinical Implications. Gastroenterology. 2023;164(5). DOI: 10.1053/j.gastro.2022.08.058

Medina-Franco H, Pimienta-Ibarra AS, Pastor-Sifuentes FU, Ramírez-Luna M. Cánceres primarios simultáneos; ¿síndrome de Lynch atípico? Vol. 80, Revista de Gastroenterologia de Mexico. 2015 DOI: 10.1016/j.rgmx.2014.11.003

Ene, C. V., Bulai, C. A., Geavlete, P., Popescu, R. I., Vacaroiu, I. A., Georgescu, D. E., Isaconi, I. V., Munteanu, M. A., Ene, C. D., Militaru, A., Geavlete, B., & Multescu, R. (2023). New Insights into Lynch Syndrome: A Narrative Review. In Chirurgia (Romania) (Vol. 118, Issue 6). https://doi.org/10.21614/Chirurgia.2023.V.118.I.6.P.584

Rosenblum, R. E., Ang, C., Suckiel, S. A., Soper, E. R., Sigireddi, M. R., Cullina, S., Belbin, G. M., Lucas, A. L., Kenny, E. E., & Abul-Husn, N. S. (2020). Lynch Syndrome–Associated Variants and Cancer Rates in an Ancestrally Diverse Biobank. JCO Precision Oncology, 4. https://doi.org/10.1200/po.20.00290

Nolano, A., Medugno, A., Trombetti, S., Liccardo, R., De Rosa, M., Izzo, P., & Duraturo, F. (2023). Hereditary Colorectal Cancer: State of the Art in Lynch Syndrome. In Cancers (Vol. 15, Issue 1). https://doi.org/10.3390/cancers15010075

La Agencia Internacional para la Investigación del Cáncer (IARC). (s/f). Observatorio Mundial del Cáncer. Iarc.P. https://gco.iarc.fr/en

Dal Buono, A., Puccini, A., Franchellucci, G., Airoldi, M., Bartolini, M., Bianchi, P., Santoro, A., Repici, A., & Hassan, C. (2024). Lynch Syndrome: From Multidisciplinary Management to Precision Prevention. In Cancers (Vol. 16, Issue 5). https://doi.org/10.3390/cancers16050849

Ahadova, A., Witt, J., Haupt, S., Gallon, R., Hüneburg, R., Nattermann, J., ten Broeke, S., Bohaumilitzky, L., Hernandez-Sanchez, A., Santibanez-Koref, M., Jackson, M. S., Ahtiainen, M., Pylvänäinen, K., Andini, K., Grolmusz, V. K., Möslein, G., Dominguez-Valentin, M., Møller, P., Fürst, D., … Kloor, M. (2023). Is HLA type a possible cancer risk modifier in Lynch syndrome? In International Journal of Cancer (Vol. 152, Issue 10). https://doi.org/10.1002/ijc.34312

Carethers, J. M., & Stoffel, E. M. (2015). Lynch syndrome and Lynch syndrome mimics: The growing complex landscape of hereditary colon cancer. World Journal of Gastroenterology, 21(31). https://doi.org/10.3748/wjg.v21.i31.9253

Burn, J., Gerdes, A. M., MacRae, F., Mecklin, J. P., Moeslein, G., Olschwang, S., Eccles, D., Evans, D. G., Maher, E. R., Bertario, L., Bisgaard, M. L., Dunlop, M. G., Ho, J. W. C., Hodgson, S. V., Lindblom, A., Lubinski, J., Morrison, P. J., Murday, V., Ramesar, R., … Bishop, D. T. (2011). Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: An analysis from the CAPP2 randomised controlled trial. The Lancet, 378(9809). https://doi.org/10.1016/S0140-6736(11)61049-0

Burn, J., Sheth, H., Elliott, F., Reed, L., Macrae, F., Mecklin, J. P., Möslein, G., McRonald, F. E., Bertario, L., Evans, D. G., Gerdes, A. M., Ho, J. W. C., Lindblom, A., Morrison, P. J., Rashbass, J., Ramesar, R., Seppälä, T., Thomas, H. J. W., Pylvänäinen, K., … Side, L. (2020). Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial. The Lancet, 395(10240). https://doi.org/10.1016/S0140-6736(20)30366-4

Goverde, A., Spaander, M. C. W., Nieboer, D., van den Ouweland, A. M. W., Dinjens, W. N. M., Dubbink, H. J., Tops, C. J., ten Broeke, S. W., Bruno, M. J., Hofstra, R. M. W., Steyerberg, E. W., & Wagner, A. (2018). Evaluation of current prediction models for Lynch syndrome: updating the PREMM5 model to identify PMS2 mutation carriers. Familial Cancer, 17(3). https://doi.org/10.1007/s10689-017-0039-1

Kastrinos, F., Uno, H., Ukaegbu, C., Alvero, C., McFarland, A., Yurgelun, M. B., Kulke, M. H., Schrag, D., Meyerhardt, J. A., Fuchs, C. S., Mayer, R. J., Ng, K., Steyerberg, E. W., & Syngal, S. (2017). Development & validation of the PREMM5 model for comprehensive risk assessment of lynch syndrome. Journal of Clinical Oncology, 35(19). https://doi.org/10.1200/JCO.2016.69.6120

Ladabaum, U. (2020). What Is Lynch-like Syndrome and How Should We Manage It? In Clinical Gastroenterology and Hepatology (Vol. 18, Issue 2). https://doi.org/10.1016/j.cgh.2019.08.009

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Copyright (c) 2025 Tannia Estefanía Aguirre-Soria, Bryan Harold Astudillo-Ramirez, Bastidas-Arévalo Bastidas-Arévalo, Alex Hernán Almeida-Robalino

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