Benign Inflammatory Process Research Articles

Clinical and morphological diagnostics of bening single focal lung lesions without necrotic changes

In recent decades, the problem of accidental detection by radiography or chest computer tomography of solitary focal formations smaller than 3 cm has become relevant. Although the primary task is to find out its benign or malignant nature as soon as possible, the clarification of the etiology of benign formations with non-neoplastic genesis retains an important clinical significance, in particular in cases of their infectious nature. The purpose of the study was to analyze the diagnostic significance of clinical and radiological data and morphological features of benign single focal lung lesions without necrotic changes, taking into account the final clinical diagnosis. The study group consisted of 42 patients with single benign focal lung lesions without necrosis. Among them there were 29 (69.0%) women and 13 (31.0%) men. Average age of the patients was (50.5±2.2) years. The total number of focal formations was 52. According to the number of focal formations, one patient was diagnosed with 1 formation in 34 cases, 2 formations in 6, and 3 formations in 2 cases. The dimensions of each of the formations did not exceed 30 mm. The most common diagnostic measures were direct biopsy at FBS, 10 (23.8%) cases; and transbronchial biopsy of lung under radiological control, 16 (38.1%) cases respectively. Among the operative interventions, lobe resection of the lung with a focus was mainly performed, in 16 (84.2%) cases. According to the results of the histological examination and taking into account the clinical and laboratory data, the following diagnoses were obtained, which corresponded to the final clinical diagnosis of the patients. A lung abscess was established in 4 (9.5%) cases; a chronic inflammatory process of a non-specific nature was diagnosed in 14 (33.3%) cases. Predominantly post-inflammatory changes and local pneumofibrosis were determined in 15 (35.7%) cases. Vascular malformation and pulmonary sarcoidosis were diagnosed once. In another 7 (16.7%) cases, the final clinical diagnosis was based on clinical and laboratory data and patient supervision - in 2 observations, the final diagnosis of chronic non-specific pulmonary disease was made; and in 5 cases, the nature of single focal pulmonary formations was not established. The most numerous subgroups were cases with a chronic nonspecific inflammatory process and with limited post-inflammatory changes (in total, they amounted to 69.0%), so the clinical and radiological indicators of these subgroups were analyzed more detail. Overall clinical data did not differ significantly between both subgroups. Females predominated in the group with post-inflammatory changes. The number of focal lesions in both lungs was equal; the upper lobes were more often affected. The average size of foci was significantly larger in patients with a chronic inflammatory process and was 22.2 mm compared to 16.3 mm in the subgroup with post-inflammatory changes (p<0.05). Single foci with minimal destructive changes were observed only in the subgroup with a chronic inflammatory process. As a result of the research, such findings were obtained. Among benign single non-necrotized focal pulmonary lesions chronic non-specific inflammatory process and post-inflammatory fibrotic changes, including focal pneumofibrosis, predominate in etiology. In our study, they accounted for 69% of all cases. According to the main radiological indicators (localization, size, shape, characteristics of the internal contents) it is impossible correct determination of the benign nature of non-necrotized focal lung lesions in the vast majority of cases. Histological examination of tissue of focal lesions not only determines benign or malignant nature of the formations, but also, in the case of their benign nature, allows clarify their etiology in most cases (83.3%). Keywords: benign non-necrotized focal lung lesions, X-ray indicators, histological diagnostics.

Procedure Guideline for Prostate Cancer Imaging with PSMA-ligand PET/CT

PSMA-PET/CT for imaging prostate cancer (PC) has spread worldwide since its clinical introduction in 2011. The majority of experiences have been collected for PSMA-PET-imaging of recurrent PC. Data for primary staging of high-risk PC are highly promising. Meanwhile, a plethora of PSMA-ligands are available for clinical use (e. g. 68Ga-PSMA-11, 68Ga-PSMA-I&T, 68Ga-PSMA-617, 18F-DCFBC, 18F-DCFPyL, 18F-PSMA-1007, 18F-rhPSMA-7 and 18F-JK-PSMA-7). However, an official approval is available only for 68Ga-PSMA-11 (approved by the US FDA in 2020) and 18F-DCFPyL (approved by the US FDA in 2021).Recommendations for acquisition times vary from 1-2 h p. i. It has been shown that for the majority of tumour lesions, the contrast in PSMA-PET/CT increases with time. Therefore, additional late imaging can help to clarify unclear findings. PSMA-PET/CT should be performed prior to commencing an androgen deprivation therapy (ADT) since (long term) ADT reduces the visibility of PC lesions. Following injection of PSMA-ligands, hydration and forced diuresis are recommended for PSMA-ligands with primarily excretion via the kidneys in order to increase the visibility of tumour lesions adjacent to the urinary bladder.PSMA-ligands are physiologically taken up in multiple normal organs. For some 18F-labelled PSMA-ligands, presence of unspecific focal bone uptake has been reported. When using these tracers, focal bone uptake without CT-correlate should be interpreted with great caution. Besides prostate cancer, practically all solid tumors express PSMA in their neovasculature thereby taking up PSMA-ligands, although usually at a lower extent compared to PC. Also multiple benign lesions and inflammatory processes (e. g. lymph nodes) take up PSMA-ligands, also usually at lower extent compared to PC.

Histopathologic evaluation of the inflammatory factors and stromal cells in the endometriosis lesions: A case-control study.

Endometriosis is a multifaceted gynecological disorder defined as a benign estrogen-dependent chronic inflammatory process in which endometrial glands and stroma-like tissues are located outside the uterine cavity. It affects around 2-10% of all women during their reproductive years. This study aimed to evaluate the traffic of mesenchymal stem cells and inflammatory factors toward the lesions. Ten samples of normal endometrium and eutopic endometrium were studied as a control group and 10 ectopic samples were considered as a case group. Hematoxylin and eosin staining was used to evaluate stromal cells and inflammatory cells. Immunohistochemical staining was performed to show the presence of proliferating cell nuclear antigen in the lesions. The cells were digested and cultured in the laboratory to study cell proliferation. The number of cells and vessels were counted with Image J software, and data analysis was performed with Prism software. Data analysis showed that the number of stromal cells and vessels in ectopic tissue were significantly higher than the control group (p 0.001). Also, the number of inflammatory cells, including neutrophils, monocytes, lymphocytes, and macrophages, in the ectopic group was much higher than in the control group (p 0.005). By expanding the number of blood vessels, blood flow increases, and cell migration to tissues is facilitated. The accumulation of inflammatory cells, especially macrophages, stimulates the growth of stem cells and helps implant cells by creating an inflammatory process.

Surgery for chronic pancreatitis and different methods of surgeries

Objectives: Chronic pancreatitis, a benign inflammatory process of the pancreas resulting in exocrine and endocrine in sufficiency. Pain is the most devastating symptom, for which patient seeks medical advice. Even though these problems are addressed medically, surgery is indicated in many cases of intractable pain. Methods: Thirty- patients who are managed surgically during November 2018 to October 2020 at our institute. Data is collected and analyzed. Various surgical procedures for chronic pancreatitis and their indications are noted. Pain relief, improvement of exocrine and endocrine in sufficiency and improvement of quality of life are studied. Results: Various operative procedures are done including intra operative Celiac plexus block in some. Puestow’s, Frey’s and Whipples PD are done in these patients, which are selected according to the pathological anatomy. We observed long lasting pain relief is observed in 90% of our patients. In two of the patient’s surgery was done in acute condition with edematous pancreas. In these cases, intra operative celiac plexus block was added. Conclusions: Surgery is effective in Chronic Pancreatitis with intractable pain and better results can be obtained with selection of procedure tailor made to the patient. Exocrine and endocrine functions may become better in some patients.

MRI and pathology findings of a mass-like fat necrosis in the breast

Fat necrosis of the breast is a benign inflammatory process and, it has a wide range of findings on Magnetic Resonance Imaging (MRI), some of which are in the malignant spectrum. We present a case of a breast fat necrosis that mimicked malignancies on MRI because of the intense internal enhancement with a type 3 kinetic curve, its relatively large size, and axillary lymphadenopathy.

Mesenteric Panniculitis Appears as Metastatic Disease on 18F-FDG-PET/CT Scan.

Mesenteric panniculitis is a rare benign inflammatory process involving mesenteric adipose tissue and the pathogenesis is still unknown. It may present 18Fluorine-fluorodeoxyglucose (18F-FDG) uptake and appear like a malign tumor or metastatic disease. We report a case of 47 year-old woman with serous ovarian adenocarcinoma demonstrating intense 18F-FDG uptake and hyperdense nodularity in mesenteric fatty tissue on post-chemotherapy positron emission tomography/computed tomography imaging. The serum tumor marker (CA-125) level was within the normal range. A correlative magnetic resonance imaging highlighted the diagnosis of mesenteric panniculitis that was also confirmed by clinical follow-up.

Xanthogranulomatous cholangitis mimicking cholangiocarcinoma: Case report and review of literature.

IntroductionXanthogranulomatous cholangitis is an extremely rare diagnosis and is believed to be an extension of xanthogranulomatous cholecystitis, a benign inflammatory process characterized by lipid-laden foamy macrophages (called “xanthoma cells”) occurring in a background of chronic inflammation consisting of lymphocytes, plasma cells, and eosinophils. Here, we report a case of xanthogranulomatous cholangitis mimicking cholangiocarcinoma.Case presentationA 72 year old male with history of recurrent cholangitis had preoperative workup highly suggestive of intrahepatic cholangiocarcinoma. He underwent right hepatectomy and portal lymphadenectomy, with pathology showing xanthogranulomatous cholangitis, with no evidence of malignancy. Interestingly, the patient did not have xanthogranulomatous cholecystitis.DiscussionWe reviewed the current literature on xanthogranulomatous cholangitis, and identified only 14 previously reported cases. In our case series, there were six female and eight male patients. Among the 14 patients, 11 presented to the hospital with jaundice. Twelve patients had preoperative workup concerning for malignancy. The diagnosis of xanthogranulomatous cholangitis was confirmed through pathology in 13 patients, and through endoscopic ultrasound biopsy in one patient. In our review, seven patients had associated xanthogranulomatous cholecystitis, three patients had an isolated case of xanthogranulomatous cholangitis, and four patients had unknown status. Our patient is the fourth case of isolated xanthogranulomatous cholangitis without xanthogranulomatous cholecystitis.ConclusionXanthogranulomatous cholangitis is a very rare phenomenon that can lead to benign strictures of the bile ducts, especially in the setting of recurrent cholangitis. It can mimic malignancies, such as cholangiocarcinoma, and should be considered in the differential diagnosis.

Mucoepidermoid carcinoma with metaplastic bone formation—A deceptive radiological presentation

AbstractMucoepidermoid carcinoma (MEC) is one of the most common primary salivary gland malignancies in both children and adults. MECs containing calcifications are rare, but well described in the literature. In contrast, there are only two case reports of MECs showing intra‐tumoural bone formation. MECs associated with calcifications occur more frequently in minor salivary glands, compared to bone formation, which is more commonly seen in major glands. This possibly points to a different pathogenic mechanism. Calcifications of the head and neck region are generally diagnosed on conventional imaging by combining the anatomical location with the pattern of calcification. The radiological findings of MECs containing calcifications or bone formation may mimic benign inflammatory processes such as sialoliths. The purpose of this paper is to report three additional cases of MEC containing metaplastic bone formation. These cases presented as painless swellings with radiological signs that could easily be mistaken for dystrophic calcifications. The clinical relevance of the paper is to make clinicians aware of the deceptive radiological appearance of this entity.

Fat necrosis as a differential diagnosis for recurrence in a treated case of breast cancer: A case report

Fat necrosis is a benign inflammatory process that can involve adipose tissue that most frequently affects peri-menopausal women. It can mimic breast cancer clinically or radiologically. The incidence of breast fat necrosis overall is roughly 0.6%, representing 2.75% of all benign lesions. Fat necrosis presents in 0.8% of breast tumors and 1–9% of breast reduction surgery cases. Most at risk are middle-aged women, with an average age of 50 years, and women with pendulous breasts. Traumatic Fat Necrosis is an important differential diagnosis to be kept in mind in Carcinoma Breast patients who are treated with surgery and adjuvant radiation therapy. We present a case where radiation is followed by a large non-healing ulcer in a known case of breast carcinoma patient.

Lymphadenopathy secondary to tattoo ink in a patient with a history of Hodgkin lymphoma.

The finding of lymphadenopathy on physical examination and radiographically can suggest a wide range of differential diagnoses for patients, including a benign inflammatory process, infection, or malignancy. This article describes a patient with a history of Hodgkin lymphoma who developed postremission left axillary lymphadenopathy caused by deposits of tattoo ink in the node.

Primary epithelioid sarcoma of the oral cavity: Review of literature and presentation of a rare entity

AbstractBackgroundEpithelioid sarcoma (ES) is a rare malignancy when diagnosed within the oral cavity. Currently, only four cases of primary ES of the oral cavity have been reported in the literature. The diagnosis of ES is difficult and requires differentiation from other sarcomas, benign inflammatory processes and squamous cell carcinoma.MethodsHerein, we have described a primary ES of the lateral oral tongue in a young female. This is the third case of primary ES of the tongue to be reported.ResultsA young female underwent partial glossectomy and post‐operative radiation for definitive treatment of a primary ES of the lateral oral tongue with no recurrence at 18 months.ConclusionEpithelioid sarcoma is a clinically aggressive sarcoma with poor overall survival. Treatment is primarily based on evidence from limited case reports and treatment of non‐head and neck soft tissue sarcomas. Treatment requires a multimodal approach including surgical excision and often postoperative radiation therapy, and close follow‐up.

Xanthogranulomatous Breast Mass: An Unusual Presentation

Xanthogranulomatous inflammatory reactions are benign inflammatory processes characterized by aggregating lipid-laden foamy macrophages. Although cases have been reported in different organ systems, these rare reactions predominantly occur in the kidney and gallbladder. We present a 92-year-old female who noticed a palpable, tender mass in the lower inner quadrant of her right breast with no skin changes. She was referred to surgery by her primary care physician on suspicion of malignancy and further evaluation. Ultrasound-guided biopsy, ordered by the primary care provider, revealed a suspicious high-grade malignant neoplasm of uncertain origin. Pathological findings include the presence of an unusual population of malignant epithelioid cells with a striking xanthogranulomatous reaction, along with numerous Touton-like histiocytes. These findings are comparable in morphology to a recently reported xanthogranulomatous epithelial tumor. Given the lack of history of breast carcinoma in this patient as well as the lack of immunohistochemical studies suggesting breast carcinoma, treatment involved continuing standard of care for an unusual high-grade sarcoma via lumpectomy. A positron emission tomography (PET) scan was ordered to ensure there was no spread or alternate origins of the cancer tissue. This case report brings to light the findings of a probable xanthogranulomatous tumor in breast tissue, an exceptionally rare phenomenon in breast cancer, especially in the elderly population. Due to the rarity of xanthogranulomatous tumors in the breast, prognosis and standardized treatment have yet to be established.

Positive Multifocal PSMA PET/CT in a Patient With Prostate Cancer and Follicular Lymphoma.

Prostate-specific membrane antigen (PSMA) PET/CT is a highly reliable nuclear tracer for diagnostic imaging of prostate cancer. However, PSMA is also expressed by some nonprostatic tissues such as benign tumors, inflammatory processes, and malignant neoplasms. This case presents a patient with prostate cancer and follicular lymphoma undergoing PSMA PET/CT. Remarkably, both tumor entities were clearly detected in the scan. Yet, the 2 malignancies demonstrated rather different ranges in terms of SUVmax uptake values and therefore still enabled precise and accurate discrimination of prostate cancer and follicular lymphoma.

Lipogranulomas of the mammary glands: diagnosis and treatment

Steatonecrosis of the mammary gland is necrosis of its adipose tissue, followed by replacement with scar tissue. Lipogranuloma is known as a benign inflammatory process, necrosis of breast fat occurs due to iatrogenic breast trauma. Most often, fatty necrosis is seen in women with large breasts – in women with small breasts, it develops much less often. It is important to diagnose lipogranulomas because it can often mimic breast cancer. Fat necrosis of the breast is a common pathological condition, with a wide variety of presentations on mammography, ultrasound and MRI. The incidence of fatty necrosis of the breast is estimated at 0.6%, representing 2.75% of all breast lesions.

Inflammatory Pseudotumor of the Temporal Bone Leading to Atypical Superior Semicircular Canal Dehiscence Syndrome: A Novel Case Report

Inflammatory pseudotumor of the temporal bone is a benign idiopathic inflammatory process that is rarely encountered in clinical practice. We describe a novel case of a patient who developed superior semicircular canal dehiscence syndrome in the setting of active inflammatory pseudotumor of the temporal bone. One female patient found to have inflammatory pseudotumor of the temporal bone. After treatment with mastoidectomy and steroids, she subsequently developed superior semicircular canal dehiscence syndrome. The patient initially underwent myringotomy and pressure equalization tube placement for a unilateral effusion. Imaging with computed tomography and magnetic resonance imaging revealed a lytic mastoid mass. A complete mastoidectomy was diagnostic for inflammatory pseudotumor and the patient was treated with adjuvant long-term corticosteroids. After this procedure, she was discovered to have new development of symptomatic superior semicircular canal dehiscence syndrome. She eventually underwent a trans-mastoid repair of her superior semicircular canal dehiscence. The patient's clinical course is described with emphasis on the development of superior semicircular canal dehiscence syndrome in the setting of active inflammatory pseudotumor of the temporal bone. The patient's radiographic and clinical history were found to be consistent with inflammatory pseudotumor of the temporal bone. She underwent a therapeutic mastoidectomy with long-term post-operative corticosteroids. During her post-operative course, she developed symptoms of vertigo, hearing loss, and autophony. She was subsequently diagnosed with superior semicircular canal dehiscence and treated with a trans-mastoid repair of the dehiscence. Her symptoms satisfactorily resolved after this surgery. Inflammatory pseudotumor of the temporal bone is a rare benign inflammatory process. We present what is to our knowledge the first description of superior semicircular canal dehiscence syndrome developing in the setting of inflammatory pseudotumor.

Relation of h. pylori to gastric cancer

Introduction: Helicobacter Pylori (H. Pylori) is a gram negative bacterium spiraled in the gastric epithelium. This bacterium is responsible for triggering benign inflammatory processes and is considered a carcinogenic agent. Methodology: This is a bibliographic review based on the analysis of published works, evaluating the relationship between H.Pylori and the development of gastric cancer based on keywords indexed in the DECs (described in science and health): “Helicobacter Pylori” “Cancer” “Stomach” “Gastric cancer” and information from INCA (National Cancer Institute). Result and Discussions: Helicobacter Pyloriinfection is associated with gastric neoplasms in which adenocarcinomas are the most prevalent, with more than 90% of cases. The diagnosis is made through EDA (Upper Digestive Endoscopy) with biopsy of the lesions and has a sensitivity of 97%. The treatment of H. pylori in the patient diagnosed with gastric cancer depends on the type of neoplasia. Conclusion: The relationship between H.Pylori and neoplastic processes is evident. Therefore, proper diagnosis and treatment in all carriers of the bacterium is essential in order to reduce the risk of developing gastric cancer.

Gastric linitis plastica due to signet-ring cell carcinoma with Krukenberg tumors diagnosed by endoscopic ultrasound-guided fine-needle aspiration.

Gastric linitis plastica is a rare condition characterized by the stiffening and thickening of the gastric wall, presenting a "leather bottle" appearance. It is generally associated with infiltration of poorly differentiated gastric cancer cells, but similar findings can arise due to metastases from other cancers and benign inflammatory processes. Despite advances in imaging modalities, pathological evaluation is required for diagnosis. As endoscopic mucosal biopsies may not be diagnostic, endoscopic ultrasound-guided fine-needle aspiration of the thickened stomach wall presents a potential diagnostic option. We report a case which presented with bilateral ovarian tumors and was ultimately diagnosed as gastric signet-ring cell carcinoma with Krukenberg tumors by endoscopic ultrasound-guided fine-needle aspiration of the stomach wall. The preoperative diagnosis allowed the patient to avoid surgery and to start chemotherapy for gastric cancer. We also review the existing literature on endoscopic ultrasound-guided fine-needle aspiration in the context of gastric linitis plastica.

Pictorial essay: incidental findings on 18F-Fluciclovine PET/CT scan

IntroductionFluorine-18 (18F) Fluciclovine (anti-1-amino-3-18F-fluorocyclobutane- 1-carboxylic acid [FACBC]) is a synthetic amino acid labeled with 18F, currently used as PET radiopharmaceutical to investigating prostate cancer, namely in the recurrent setting.Fluciclovine is transported to cell membranes by amino acid transporters, such as LAT1 and ASCT2. The upregulation of LAT-1 and ASCT2 activities is typical of prostate cancer but is also present in other pathological conditions such as non-prostatic neoplasms (e.g., lung cancer) and in benign inflammatory process (e.g., benign prostatic hyperplasia, chronic prostatitis, high-grade prostatic hyperplasia intraepithelial).MethodsIn this short essay we present a retrospective FACBC PET/CT analysis consisting of a selection of the five most relevant cases of patients referred in our centre to FACBC PET/CT for prostate cancer, with concomitant FACBC uptake in sites atyipical for prostate cancer.ResultsThese five selected cases demonstrate FACBC uptake at the level of the pancreatic head, adrenal incidentalomas, pulmonary nodules, mediastinal lymph nodes and neoformative tissue of the rectal wall.DiscussionClinical cases selected in this pictorial essay have demonstrated that Fluciclovine is not an exclusive and specific radiotracer for prostate cancer and, therefore, can induce misdiagnosis. In fact, incidental benign and malignant uptake might occur and should be further evaluated with clinical correlation or other imaging.

Case report: xanthogranulomatous cholangitis mimicking cholangiocarcinoma

Presenter: Jenny Q Zhang MD | Rhode Island Hospital Background: Xanthogranulomatous cholangitis is an extremely rare diagnosis and is believed to be an extension of xanthogranulomatous cholecystitis, a benign inflammatory process characterized by lipid-laden macrophages. Here, we report a case of isolated xanthogranulomatous cholangitis mimicking cholangiocarcinoma. Methods: A 72-year-old male who was previously admitted to the hospital for gallstone pancreatitis, cholangitis s/p ERCP with plastic stent placement, and Klebsiella bacteremia underwent interval laparoscopic cholecystectomy with liver biopsy. His pathology revealed chronic cholecystitis and no fibrosis, steatosis or inflammation in the liver biopsy. Postoperatively, he continued to endorse night sweats, unintentional weight loss, and jaundice. He underwent ERCP with exchange of the common bile duct stent multiple times with no alleviation of symptoms. Liver function tests remained mildly elevated (Tbili 1.3, AST 78, ALT 64, Alk Phos 673). CEA was normal (1.1) but CA19-9 was significantly elevated at 160. CT abdomen/pelvis showed new intrahepatic duct dilation and portal vein thrombus. ERCP with SpyGlass revealed right hepatic system underfilling, narrowing of the right intrahepatic duct takeoff, and abnormal biliary tract mucosa characterized by nodularity, scarring, purulence, and decreased vascularity. Cytology of the right main hepatic duct showed atypical cells. Given the constellation of findings, there was high clinical suspicion of early intrahepatic cholangiocarcinoma and he was consented for liver resection. Results: The patient subsequently underwent right hepatectomy and portal lymphadenectomy. Pathology showed xanthogranulomatous cholangitis of large hepatic bile ducts, bile granuloma, hepatic parenchyma with features of large bile duct obstruction, chronic cholestasis, and biliary pattern of fibrosis with bridging septa. Dedicated stains for bacteria and fungi were negative, and there was no evidence of malignancy. He tolerated the procedure well and was discharged home with services on postoperative day 4. Conclusion: We present a patient with initial workup concerning for intrahepatic cholangiocarcinoma. Final pathology showed xanthogranulomatous cholangitis with no malignancy. Interestingly, he did not have xanthogranulomatous cholecystitis. Xanthogranulomatous cholangitis is a very rare phenomenon that can lead to benign strictures of the bile ducts, especially in the setting of recurrent cholangitis.

S1651 Intussusception in an Elderly Adult Male

INTRODUCTION: Intussusception rarely occurs in adults and is often due to adhesions, inflammation, benign lesions or malignancy. Classic symptoms that present in children such as currant jelly stools or palpable abdominal mass are absent in adults and thus diagnosis is reliant on abdominal imaging. The etiology of intussusception in adults should be investigated due to the concern for malignancy as a cause. We report a case of a patient with intussusception attributed to a dysplastic tubulovillous adenoma in the sigmoid colon found on colonoscopy. CASE DESCRIPTION/METHODS: A 61-year-old male with IBS presented for acute worsening of his chronic abdominal pain after eating breakfast. The pain was sharp and located in the left lower quadrant radiating to the epigastrium. He denied the pain changing with food and denied any diarrhea or infectious symptoms. He experienced a 15-pound weight loss in the past year. He had never undergone a colonoscopy. Initial lab workup was unrevealing with a normal complete metabolic panel and lipase. A CT of the abdomen was performed showing a short segment intussusception in the descending colon without obstruction. The patient underwent a colonoscopy which showed a non-obstructing mass in the sigmoid colon. Biopsies of the mass revealed tubulovillous adenoma with high-grade dysplasia. The patient was referred to colorectal surgery and underwent successful left hemicolectomy. DISCUSSION: Colonic intussusception in adults can be due to benign polyps, inflammatory processes, adhesions, or malignancy, which comprises more than half of all adult cases. Malignant lesions may compress the walls of the intestine interfering with peristalsis and the point at which this occurs is known as the lead point. The altered peristalsis may lead to that segment of bowel invaginating into another, resulting in an intussusception. This causes obstruction which manifests as obstructive symptoms such as abdominal pain, constipation, nausea, and vomiting. Patients may also have a waxing and waning pattern of symptoms, as the intussusception may self-resolve and recur later. CT imaging may diagnose intussusception based on the presence of bowel invagination, however, the lead point is unlikely to be identified on CT imaging alone. Due to the high suspicion for malignancy acting as a pathologic lead point, adult patients presenting with colonic intussusception should undergo colonoscopy to investigate possible malignant causes of intussusception.Figure 1.: CT of the abdomen showing short segment intussusception in the descending colon (arrow).Figure 2.: Endoscopy image of a mass in the sigmoid colon.