Mass In Transverse Colon Research Articles

EP.TH.717Triple tumour: A myriad of serial incidental findings in a patient presenting with Gallstone pancreatitis

Abstract Aim To present a rare incidental synchronous triple tumours - colonic adenocarcinoma, endometroid ovarian adenocarcinoma and benign Brenner tumour in a patient admitted with acute gallstone pancreatitis. Methods A 75-year-old female presented with epigastric pain. Blood-tests and USS abdomen confirmed gallstones and pancreatitis. She was treated conservatively. USS also showed incidental pelvic mass which was further characterised by CT and MR scans. These scans confirmed heterogeneous lobulated mass in the left adnexa. CT scan also picked-up incidental mass in transverse colon, which was confirmed as cancer by colonoscopy. She was offered therapeutic resection after discussion in Colorectal and Gynaecology MDT. Intra-operatively, transverse colonic tumour was invading into the proximal ileum. Laprascopic surgery concluded with extended right hemicolectomy, small bowel resection-anastomosis, omentectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy. Results The patient had gradual recovery without any complications. Histopathology showed T4N2 poorly differentiated adenocarcinoma of colonic mass, FIGO grade 1 stage 1c endometrioid adenocarcinoma of left ovary and benign brenner tumour of right ovary. Post-operative MDT did not offer adjuvant-therapy due to slow recovery and fraility. So far, two-years of follow-up did not show any recurrence. Conclusion This report adds to the limited literature of triple synchronous tumours, including rare Brenner accounting for 5% of benign ovarian tumours and endometrioid ovarian tumour with an incidence of 4 -7%. Multi-disciplinary approach and combined surgery can achieve a desirable outcome in such complex cases. It is crucial to identify the primary status of the tumours as it will guide the adjuvant treatment.

Iron Deficiency Anemia as The Only Manifestation of Colon Cancer in Male Patient: A Case Report

Iron deficiency anemia can be the first manifestation of colon cancer. However, iron deficiency anemia is also common in other benign conditions, which may cause a longer delay for referral decisions to get a definitive diagnosis. This is a case of 40-year-old male patient who had only iron deficiency anemia as a manifestation of colon cancer. Colonoscopy revealed intraluminal mass in transverse colon. After resection of the tumor, histopathology showed well-differentiated mucinous adenocarcinoma, invasion of sub-serous, and one node positive (pT3pN1pM0). After resection, we administered XELOX as adjuvant chemotherapy every 3 weeks for 8 cycles.

S1647 A Surprising Diagnosis of Lynch Syndrome at Age 86

INTRODUCTION: Lynch syndrome (LS) is the most common inherited colorectal cancer (CRC) syndrome and accounts for up to 6% of all CRCs in the United States. The lifetime risk of CRC is near 75% for individuals with this inheritable highly expressed gene making identification of individuals and at-risk family members important for cancer prevention and management. CASE DESCRIPTION/METHODS: 86-year-old male in excellent physical condition with history of right-sided poorly differentiated invasive stage IIa adenocarcinoma status post right hemicolectomy 12 years ago presented after 6 episodes of painless hematochezia (hemoglobin 11.9 g/dL). He chose not to undergo chemotherapy and never had a follow-up colonoscopy following his initial CRC. He reported a family history of 1 sister who recovered from breast cancer and 2 deceased younger brothers who passed from colon cancer after his original diagnosis of CRC. Both parents experienced early death from cardiovascular disease. He had 6 children. Colonoscopy revealed normal ileocolonic anastomosis but with a 3 cm ulcerated, friable mass in transverse colon, a 2.5 cm mass in rectosigmoid colon, and a large, fungating 4cm ulcerated mass 5 cm from the anal verge. CT chest/abdomen/pelvis scan demonstrated extension of the transverse colonic mass through the colon wall into the mesentery with extensive nodal and hepatic metastatic disease. Pathology revealed invasive moderately differentiated adenocarcinoma positive for MLH1, MHS2, and PMS2 suggestive of Lynch syndrome; absent MSH6 staining was noted. Family members were recommended for genetic testing. The patient ultimately opted against treatment. DISCUSSION: The average age of colon cancer diagnosis for those with LS is 44 as compared to 68 for men without the genetic syndrome. This case demonstrates a particularly unique diagnosis of Lynch syndrome in an elderly male that was not diagnosed until his second bout of CRC. Of note, both cancers occurred after age 70. Strict adherence to the revised Bethesda guidelines can miss 68% of high microsatellite instability CRCs suggesting these guidelines are inadequate for LS screening, particularly if a full multigenerational family cancer history is not available. Multiple studies have demonstrated economic feasibility and advocate for universal LS testing of CRC tumors. This case supports such a paradigm. For identifying those who may be at risk for LS, we would prefer a predictive model without an overreliance on age to determine those appropriate for screening.Figure 1.: Endoscopic view of the 3 cm transverse colon (A), 2.5 cm rectosigmoid colon (B), and 4 cm anal verge (C) masses in an 86-year-old male discovered to have Lynch syndrome.Figure 2.: CT abdomen/pelvis showing transverse colon carcinoma with direct extension through the colon wall (red arrow) and into the mesentery associated with extensive nodal, as well as hepatic (yellow arrows) metastatic disease in an 86-year-old male discovered to have Lynch syndrome.

An Adenoma with a Twist: Colonic Intussusception

Intussusception defined as invagination of the proximal intestine into a distal segment with most commonly affected population being children younger than two years old, although rare, is reported to occur in adults aswell. Commonly affected sites involve the terminal ileum at the ileocecal junction which accounts for 90% of the cases. In adults, small bowel intussusception is often reported on abdominal imaging. This finding is considered to be idiopathic and of no clinical significance in most cases. However, colonic intussusception is often the result of a lead point obstruction requiring further evaluation. We present a case of a 37 year old male with history of anxiety and depression, who presented with complains of intermittent abdominal pain ongoing for several weeks. The pain was located in the periumbilical region and described as sharp and spasmodic in nature. It occurred for a short duration in 2-3 hour intervals with complete resolution of pain between these periods. His symptoms were also associated with melena and hematochezia. At the time of his presentation, abdominal CT was performed which revealed colonic intussusception with telescoping of the hepatic flexure into the proximal transverse colon without evidence of masses or obstruction. Colonoscopy was pursued thereafter, which revealed a 7-8 cm polypoid mass in the proximal transverse colon causing partial obstruction and active torsion of colonic tissue, however the colonoscope was able to pass this area with moderate difficulty. Biopsies of the mass were sent for pathologic analysis and revealed features of tubulovillous adenoma with focal serrated architecture and surface inflammatory exudate. CEA tumor marker was obtained which was within normal limits. Patient underwent a laparoscopic assisted right hemi colectomy with partial omentectomy. The mass in the transverse colon was excised and confirmed tubulovillous adenoma. The patient had an uncomplicated post-operative course with resolution of symptoms. This is an unusual case of colonic intussusception in an adult male secondary to a large benign adenomatous lesion acting as a lead point. Although rare in adult population, pathologic intussusception of the colon should be considered in the differential of spasmodic or episodic pain in the mid or lower abdominal region and, radiographic findings of colonic intussusception should be investigated endoscopically to define the etiology

Hodgkin's disease of the gastrointestinal tract

Hodgkin's disease (HD) is rarely considered in the differential diagnosis of gastrointestinal (GI) disorders. We report eight cases of GI HD. The patients, ages 16-64, all with stage IV disease of varied histologic subtypes and GI symptoms including pain, upper or lower GI bleeding and/or obstruction. There was diffuse gastric fold thickening in one case, a large submucosal mass along the proximal greater curvature in another case, and a large ulcerating mass along the lesser curvature in the third case. Two cases of jejunal disease manifested as either a short or long segment of luminal narrowing with prominent mucosal nodularity. Another case exhibited a short area of complete mucosal destruction, irregular cavitation and intraluminal filling defect. In one additional case there was diffuse jejunal nodularity. Colonic involvement (two cases) presented as a solitary polypoid mass in transverse colon in one patient and severe narrowing of the descending colon with adjacent mesenteric mass on CT in another. We conclude that although rare in Hodgkin's disease, GI involvement should be considered, particularly in patients with stage IV disease.