Anorectal Cancer with Bone Marrow andLeptomeningeal Metastases

This is an interesting case of anorectal signet ring carcinoma withfirst presentation of an early stage disease, showing theaggressive disease and the undetectable behavior of this type of histology which can mislead diagnosis. Brain/CNS metastasisfrom colorectal cancer (CRC) is rare occurring in 3% of cases, and leptomeningeal carcinomatosis (LMC) is extremely rare inCRC (<0.02%). Symptoms and signs of LMC are pleomorphic and may be localized to three compartments: cerebralhemispheres, cranial nerves, and spinal cords and roots. Treatment of metastatic rectal cancer has been improving over the lastfew years with a lot of changes toward longer survival and improvement in quality of life and to change the disease into achronic condition. However, in our case, the overall survival from the onset of LMC was 3 weeks only. Revising the evidencein the treatment of signet ring histology of rectal cancer, there is no specific treatment recommendation that is for thishistology and for such very aggressive behavior which could be considered as a separate entity to the classic adenocarcinomahistology.