Breaking Boundaries: An Unusual Case of Rectal Signet Ring Cell Carcinoma Invading the Uterus and Mesentery

Abstract

Signet ring cell carcinoma (SRCC) of the rectum is an infrequent and highly malignant subtype of colorectal cancer. Representing a small fraction of all colorectal carcinomas, SRCC is characterised by its aggressive clinical course, delayed presentation, and poor prognosis. The diagnosis is often established at advanced stages due to its insidious onset and nonspecific symptoms. We present a rare case of a middle-aged female with primary rectal SRCC who initially presented with symptoms suggestive of anaemia and urinary abnormalities. Laboratory investigations revealed microcytic anaemia, positive stool occult blood, and significant proteinuria. Radiological imaging and histopathological examination confirmed a diagnosis of poorly differentiated signet ring cell adenocarcinoma of the rectum, with extensive metastatic spread to the uterus, mesentery, liver, and para-aortic lymph nodes. This case underscores the diagnostic complexity of rectal SRCC due to its atypical presentation and rapid progression. It emphasises the necessity for a high index of clinical suspicion, even in the absence of overt gastrointestinal symptoms, and advocates for a comprehensive diagnostic workup including advanced imaging and histological evaluation to facilitate early detection and timely intervention.