Abstract
A 57-year-old man with left back pain, anorexia, and weight loss was referred for evaluation of multiple colon polyps. Laboratory studies showed iron deficiency anemia, a fecal occult blood test was positive, and tumor markers (carcinoembryonic antigen, CA 19-9) were within normal ranges. Colonoscopy showed 7 polypoid lesions of 5 to 10 mm diameter scattered throughout the colon. Each had either an erosion or a depression at the top, and all appeared to be submucosal (A; 0.2% indigocarmine). Barium contrast radiographs confirmed the endoscopic findings including the convergence of folds around the lesions. EGD showed a large, ulcerated tumor in the stomach (B). Enhanced CT demonstrated enlarged para-aortic lymph nodes. Biopsy specimens from the stomach (C; H&E, orig. mag. ×40) and colon lesions (D; H&E, orig. mag. ×40) showed poorly differentiated adenocarcinoma. Scintigraphy revealed metastases in the left scapula and sternum. Chemotherapy was initiated with 5-day courses every 4 weeks of cisplatin (16 mg/m2) administered intravenously over 1 hour beginning at 6:00 pm and continuous infusion of 5-fluorouracil (350 mg/m2) for 12 hours beginning at 7:00 pm. The back pain improved remarkably after the first course. The metastatic colonic lesions disappeared without scar formation after the third course. Partial responses with respect to the gastric tumor and para-aortic lymphadenopathy were evident after the fifth course. Performance status gradually improved and the patient was discharged 32 weeks after admission.
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