Radiation-induced colon cancer with high frequency microsatellite instability (MSI-H), report of a case

We report a 67-year-old female with radiation-induced colon cancer which developed 23 years after radiation therapy for cancer of the endometrium. She was strongly suspected to be a case of hereditary nonpolyposis colorectal cancer (HNPCC) due to her clinical manifestations, i.e. metachronous multiple cancer developed in the endometrium and colon. MSI test and immunohistochemistry for mismatch repair (MMR) proteins revealed that MSI was highly positive and expression of hMSH2 was lost in the colon cancers. Further, on examining the genetic change, the point mutation, ACG→ATG, responsible for amino acid change, was detected in codon8 (exon1) of the hMSH2 gene. The change, however, could be a polymorphism of this gene and further analyses were necessitated to confirm the genetic background for HNPCC. Interestingly, three cancers with adenoma were located in the mucosa of radiation colitis, in which several atypical glands were also found. This is the only case of radiation-induced colorectal cancer with MSI-H in our hospital. Because of our previous studies, we believe that the genetic pathway in carcinogenesis of the radiation-induced colon cancer is different from that of HNPCC, despite their having several kinds of clinical and pathological features in common. (author)