P0270 - An Unusual Presentation of the Brain Metastasis From Mucinous Colorectal Adenocarcinoma With KRAS Mutation Presenting as Seizures

Shreel H. Patel, MD¹, Oliverio Abarca Guzman, MD¹, Baron Ekeledo, MD¹, Mark Lavering, ², Bareera Akhtar, MD^1
1UTRGV-Knapp Medical Center, Weslaco, TX; ²UTRGV School of Medicine, Edinburg, TX

Introduction: Colon cancer is the third most common cancer and third leading cause of the cancer deaths in USA. The colon cancer is preventable cancer by the means of screening colonoscopies. Most of the time when the patient presents with the symptoms of colon cancer, it is already spread to liver and lungs, therefore decreasing the survival rates of the patient. In rare instances the colon cancer can spread to brain. Therefore we present a case of brain metastasis from proximal mucinous colon adenocarcinoma which presented as epileptic seizures.

Case Description/Methods: A 69 year old gentleman with known history of essential hypertension and BPH presented to the emergency department with the chief complaint of intermittent lower abdominal pain, weight loss of 60 pounds in last 3 months and described change in stool caliber. His last colonoscopy in 2016 was normal and no family history of colon cancer. As part of workup the Ct scan of the abdomen and pelvis was done which showed infiltrative mass in the ileocecal region with omental thickening and metastasis to liver and lungs. Labs were done simultaneously, CEA was 45.1 , AFP 3.5 and CBC suggestive of iron deficiency anemia. Soon he was operated for the mass and it came out to be mucinous colon adenocarcinoma with KRAS mutation. He was postoperatively admitted on telemetry floor and suddenly on postop day 4 he developed tonic-clonic jerky movements of the upper extremities and rolling of eyes, diagnosed with new onset of epileptic seizures and CT Scan of the head was done which showed right sided frontal lobe mass of 1.6 cm with vasogenic edema. The patient was immediately started on dexamethasone and neurosurgeon was consulted and was considered for whole brain radiation with chemotherapy for the colon cancer.

Discussion: Colon cancer most commonly metastasis to the liver and lungs. In some instances, it can metastasis to the brain. The incidence of brain metastasis is 2.3% in total from the colorectal cancer. The most common risk factors studied retrospectively till today is based on total CEA level on presentation, tumor burden, metastasis and age of presentation. There is no such protocol or guideline to scan for brain metastasis if the patient presents with the colorectal cancer. The main learning point form this case report or cases similar like this is to whether screen patients for the brain metastasis or not. Should we start working on further risk stratification system for the screening by using retrospective data from EMR database?



Disclosures:


Shreel H. Patel, MD¹, Oliverio Abarca Guzman, MD¹, Baron Ekeledo, MD¹, Mark Lavering, ², Bareera Akhtar, MD¹. P0270 - An Unusual Presentation of the Brain Metastasis From Mucinous Colorectal Adenocarcinoma With KRAS Mutation Presenting as Seizures, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.