Rectal Adenocarcinoma With Enteroblastic Differentiation and Hepatic Metastases: A Rare and Aggressive Variant of Colorectal Carcinoma

11 July 2026 : Case report USA

Unusual clinical course, Mistake in diagnosis, Unusual or unexpected effect of treatment, Adverse events of drug therapy

Farzeen Fatma Syed^{ABCDEF 1*}, Ahmed Khalid^{ABCDEF 2}

DOI: 10.12659/AJCR.953084

Am J Case Rep 2026; 27:e953084

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Table 1 Immunohistochemical and molecular features supporting rectal adenocarcinoma with enteroblastic differentiation.

Marker/feature	Rectal mass	Liver biopsy	Interpretation
SALL4	Positive	Positive	Oncofetal/enteroblastic marker
MOC31	Positive	Positive	Epithelial marker
BerEP4	Positive	Not reported	Supports epithelial differentiation
Claudin-4	Positive	Not reported	Supports epithelial differentiation
Glypican-3	Patchy positive	Weak/patchy positive	Supports enteroblastic differentiation
CK7	Not reported	Positive	Contributed to initial pancreaticobiliary impression
CK20	Negative	Not reported	Loss of typical intestinal marker in rectal tumor
CDX2	Negative	Focal positive on initial outside interpretation	Discordant intestinal marker staining contributed to diagnostic confusion
Villin	Not reported	Focal positive on initial outside interpretation	Supported initial outside interpretation
SATB2	Patchy positive	Not reported	Limited support for colorectal origin
NKX3.1/PSA	Negative	Not reported	Argues against prostatic origin
PAX8/WT1	Negative	Not reported	Argues against Müllerian/renal origin
GATA3	Negative	Not reported	Argues against urothelial/breast origin
Synaptophysin/chromogranin	Negative	Not reported	Argues against neuroendocrine differentiation in rectal tumor
p40	Negative	Negative	Argues against squamous differentiation
Molecular profiling (overall)	—	—	ERBB2 amplification, KRAS/NRAS wild-type status, microsatellite stability, low tumor mutational burden, and pathogenic SMAD4 and APC alterations

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