Mimicking Colon Cancer Research Articles

The diagnostic challenge of gastrointestinal tuberculosis mimicking colon cancer: A case report

Gastrointestinal tuberculosis (TB) accounts for 3.5% of extrapulmonary TB cases and is associated with active or inactive pulmonary TB in 76% of cases. A 53-year-old lady with no prior history of morbidity visited our hospital's department with weakness, an inability to eat, a 39°C fever, no chills, and night sweats that had been present for about six months. Additionally, a colonoscopy revealed a mamelonated mass of a stenotic character in the ascending colon, along with minor mesenteric adenitis, on computed tomography scans of the abdomen and pelvis. The obtained specimen's histological analysis revealed histiocytes and a few large cells producing granulomas without neoplastic features. The colonic biopsy's Löwenstein-Jensen medium culture revealed development of the Mycobacterium TB complex. After receiving therapy for two months with rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by four months with rifampicin and isoniazid, the patient had significantly improved. The current case serves as an example of the difficulty in diagnosing GI TB. The lack of symptoms and occasionally false-positive imaging results reinforce the necessity for increased clinical suspicion.

An unusual case of gastrointestinal fungal infection mimicking colon cancer: a case report

Fungal gastrointestinal infection causing bowel obstruction mimicking the presentation of colon carcinoma is rare. We reported a case of gastrointestinal fungal infection in an immune-competent individual who presented with acute colonic obstruction. He was successfully treated with combination of surgical intervention and antifungal regimes.

Hepatic and Extrahepatic Fascioliasis Mimicking Colon Cancer with Hepatic Metastasis

<i>Fascioliasis hepatica</i> is a rare parasitic infection affecting the hepatobiliary system. On the imaging examination, it presents as multiple hepatic abscesses and bile duct dilatation. Extrahepatic fascioliasis of the gastrointestinal tract is a rare condition, resulting from the duodenal migration of fasciola flukes. The current case showed both hepatic and colonic masses, mimicking colon cancer with hepatic metastasis. However, diagnostic clues from multimodality approaches, especially in combination with magnetic resonance imaging, led to an accurate diagnosis of hepatic and extrahepatic fascioliasis.

Fish bone perforation mimicking colon cancer: A case report.

Most patients who ingest fish bones do not develop any complications. The small proportion of patients who do complicate, present with non-specific symptoms. A 64-year-old female patient presented with a 2-month history of abdominal pain. Following clinical evaluation and computed tomography scan of the abdomen, a provisional diagnosis of colon cancer was made. Histology of the resected bowel at hemicolectomy demonstrated a perforation by fish bone with an associated abscess. The case illustrates how fish bone perforation may mislead unsuspecting clinicians and may be misdiagnosed as colonic cancer.

Mass-forming ischemic colitis that mimics colon cancer.

Mass-forming ischemic colitis that mimics colon cancer.

Sigmoid colonic endometriosis mimicking colon cancer: A case report

Endometriosis is common in women of reproductive age, which can involve the intestinal tract. However, large bowel obstruction is an extremely rare complication of colonic endometriosis. In this article, we present a case of intestinal endometriosis with the symptom of rectal bleeding in the menstrual period for 1 year. Colonoscopy showed a semicircular tumor with luminal narrowing at rectosigmoid junction. The pathology of biopsy specimen revealed endometrial glands by repeated check after reviewing the patient's history. Surgical resection was performed because of luminal stricture. Intestinal endometriosis should always be kept in mind as a differential diagnosis in reproductive‐aged female patients who have symptoms of gastrointestinal bleeding and abdominal pain in the menstrual period.

Colonoscopy Preparation-Related Ischemic Colitis Presenting as a Colonic Mass

Purpose: The incidence of ischemic colitis is estimated to be 4.5 to 44 cases per 100,000 person-years. Patients typically present with painful diarrhea followed by hematochezia. This case report highlights an unusual presentation of ischemic colitis presenting with an obstructing mass mimicking colon cancer. A 66-year-old overweight female with 50 pack-years of tobacco use and chronic obstructive pulmonary disease presented as an outpatient with a change in bowel habit and hematochezia. The patient presented to the ER with diffuse severe abdominal pain and rectal bleeding following standard preparation for colonoscopy with polyethylene glycol solution. On examination her pulse was 118/min and tenderness was present in left lower quadrant without rebound tenderness, guarding, or rigidity. The WBC count was 14,000/uL, hemoglobin was 13.4 gm/dL, and MCV was 84.3. A CT scan showed proctosigmoiditis with segmental dilatation of the descending colon. A colonoscopy showed a 12-cm-long partially obstructing rectosigmoid mass starting 12 cm from anal verge. Above the mass erythema, edema, friability, ulceration, and surface hemorrhage were present. As a result it was difficult to delineate the proximal border of the mass. Multiple diverticula were seen in right colon. Biopsies of the mass showed small vessel vascular proliferation with hyaline thrombi suggestive of ischemic changes. In view of the endoscopic findings, which were highly suspicious for malignancy, a repeat colonoscopy was performed. Repeat biopsies showed hyalinized blood vessels with fibrinoid necrosis. The patient's symptoms did not improve with fluid resuscitation and antibiotics. Consequently, an exploratory laparotomy, left colon resection, proctectomy, and end colostomy with Hartmann's pouch were performed. At the time of surgery good pulses were noted in inferior mesenteric vessels. The final pathology confirmed ischemic colitis; there was no evidence of malignancy. A hypercoaguable workup was performed and was negative. Griffith's spot (splenic flexure) and Sudeck's point (junction of sigmoid colon and rectum) where collaterals converge are the areas most susceptible to ischemic injury. Ischemic injury can occur in other segments of the colon. Hyalinization of lamina propria, atrophic microcrypts, and transmural fibrosis are pathognomonic features of ischemic colitis. Edematous, hemorrhagic, or necrotic mucosa is seen in acute phase, while strictures or loss of haustrations can be found in the chronic phase. The finding of the mass is uncommon in patients with ischemic disease. This clinical vignette illustrates that patients with ischemic colitis may present with mass lesions in the chronic phase.

New Therapies, Increased Risk for Old Infections—Abdominal Tuberculosis Mimicking Colon Cancer During Adalimumab Treatment for Rheumatoid Arthritis

New Therapies, Increased Risk for Old Infections—Abdominal Tuberculosis Mimicking Colon Cancer During Adalimumab Treatment for Rheumatoid Arthritis

A Retained Foreign Body Mimicking Colon Cancer

Retained foreign bodies can be a challenging diagnosis due to the wide array of presentations and greatly varied range of time to detection. Here we report a case of a retained surgical sponge detected 5 years postoperatively after an extensive workup for colon cancer. This case demonstrates the novel finding of a retained surgical sponge appearing as colon cancer and serves as a reminder that symptoms that cannot be explained by a standard workup, in any patient who has undergone previous surgery, must have retained surgical instruments as a differential diagnosis.

Suture Granuloma Mimicking Colon Cancer

Purpose: Our case discusses one of the rare causes of a cecal mass. A 49 year old man presented with right lower quadrant abdominal pain to his primary care physician's office two years after a laparoscopic appendectomy. He was referred for colonoscopy, which revealed a 4 cm x 4 cm, soft, friable appearing mass in the Cecum. A clinical diagnosis of colonic neoplasm was made and discussed with the patient. Pathology results showed diffuse chronic inflammation, with no evidence of carcinoma. The patient then sought a second opinion and eventually presented to our office for a third opinion. After clinical evaluation and further work-up, which included a small bowel follow through to exclude an abnormal presentation of Crohn's, and review of previous colonoscopies and imaging studies, surgical resection of the mass was recommended. It was thought that the initial biopsies had missed the cancerous portions of the mass. Gross examination of the mass demonstrated many sutures from the appendectomy 2 years prior. Pathological examination of the resected specimen showed suture granulomas with abscess formation with no evidence of neoplasm. This case demonstrates a very rare example of granuloma formation secondary to foreign body (sutures) presenting as a Cecal mass and mimicking colon cancer on colonoscopy. The common differential diagnosis for a mass in the cecum for a patient with previous appendectomy includes, but is not limited to, large polyps, diverticulitis-associated mass, inflammatory bowel disease, colon cancer and lymphoma. Although rare, physicians, including those who perform colonoscopies should be aware of the possibility of suture granulomas presenting as Cecal masses in patients who have undergone appendectomies.Figure: Friable mass in the cecum.Figure: Foreign body giant cell granulomas containing suture material in the wall of the cecum.

A Case of Colonic Endometriosis Mimicking Colon Cancer

A Case of Colonic Endometriosis Mimicking Colon Cancer

Gastrointestinal basidiobolomycosis: an unusual fungal infection mimicking colon cancer.

Abstract Context.—Basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum, an environmental saprophyte found worldwide. Patients with B ranarum infection may present with sub...

Sigmoid plasmacytoma mimicking colon cancer in a patient with multiple myeloma: case report and review of literature

Colonic plasmacytomas are a rare manifestation of a myeloma malignancy, with fewer than 25 cases reported. We report such a case occurring in the sigmoid colon mimicking symptoms of colon cancer and review the literature. Awareness of this complication in patients with multiple myeloma is important in providing early diagnosis and treatment. We recommend prompt early colonoscopies for symptomatic patients with myeloma.

A Large Sigmoid Mass Mimicking Colon Cancer in a Pregnant Female

Purpose: A 36 year old, gravida 3, para 0020 pregnant female presented to the emergency department with crampy abdominal pain and constipation. An ultrasound demonstrated an intrauterine pregnancy and a complex left adnexal cystic mass. MRI revealed a multicystic left adnexal mass and an 8 cm soft signal into the distal sigmoid, suspicious for an infiltrative mural lesion. The patient underwent flexible sigmoidoscopy which revealed a 7 cm polypoid, non-obstructing mass in the distal sigmoid, 18 cm from the anal verge. Biopsies revealed endometriosis without neoplasia. The patient was counseled and elected to continue her pregnancy. She developed preeclampsia, but otherwise underwent an uneventful caesarian section at 39 weeks. Endometriosis is a common diagnosis, affecting 15% of premenopausal women. The gastrointestinal tract is the most frequently involved site of extrapelvic disease, seen in 37% of patients with endometriosis. Of these patients, the rectum and sigmoid are the most commonly involved areas. Blood per rectum during menstruation is the most common presenting symptom. Frequently, cyclical abdominal pain and altered bowel habits are present. In rare instances, obstruction and even perforation can occur. Diagnosis is difficult, typically requiring laparoscopy or endoscopy with biopsy for definitive diagnosis. Mucosal involvement is uncommon. Furthermore, endometriosis appearing as a large focal colonic mass is rare. Treatment of intestinal endometriosis can range from a strategy of watchful waiting to hormonal treatment to surgery or resection.Figure: Sigmoid mass on MRI.Figure: Sigmoid mass on endoscopy.

Sigmoid Plasmacytoma Mimicking Colon Cancer in a Multiple Myeloma Patient

Purpose: Colonic plasmacytomas are a rare manifestation of a myeloma malignancy, with less than 25 cases reported. We report such a case occurring in the sigmoid colon with the symptoms mimicking colon cancer and review the literature. Awareness of this complication in patients with multiple myeloma is important to provide early diagnosis and treatment. A 52-year-old man presented to the emergency room with intermittent hematochezia for several weeks. He was diagnosed with multiple myeloma two years previously and had been treated with chemotherapy and bone marrow transplantation. The initial response to treatment was favorable, and his disease was in remission at the time of presentation. There was no family history of colorectal cancer and no previous screening colonoscopy. He denied alcohol ingestion, non-steroidal anti-inflammatory drug use, and smoking. His vital signs were normal. Initial hematocrit was 21.7% and he received blood transfusions. Two days after admission, colonoscopy revealed a large fungating, partially obstructing mass in the lower sigmoid colon (Figure A); the remainder of the colon was normal. Biopsied specimens from the mass lesion were consistent with plasmacy-toma, and immunohistochemical stains showed strong expression of CD138 and CD79a by the neoplastic cells (Figure B). At exploratory laparotomy, the mass was large and extended into the sigmoid mesentery, anterior rectum and bladder. Surgical resection included the sigmoid colon, upper rectum, and a portion of the posterior superior bladder. On histologic examination, the 12 cm diameter plasmacytoma invaded through the wall of the colon into the pericolonic fat; seven lymph nodes were all negative. The patient recovered uneventfully and further chemotherapy was planned as an outpatient. Extra-medullary colonic plasmacytoma is a rare manifestation of multiple myeloma. It has many different presentations, including rectal bleeding or bowel obstruction. The endoscopic appearance has no characteristic features to differentiate it from other tumors, and thus biopsy is essential. Though there are no defined treatment guidelines, surgical resection and chemotherapy have been used for localized colonic presentations. Manifestation of these symptoms in myeloma patients should prompt early colonoscopies for effective and early diagnosis and treatment.Figure A: Mass in sigmoid colon seen by colonoscopy. Figure B. Multiple plasmacytoma cells on sigmoid mass biopsy expressing CD138 (H&E, original magnification x40).

Colonic Endometriosis Mimicking Colon Cancer on a Virtual Colonoscopy Study: A Potential Pitfall in Diagnosis

Colonic endometriosis has been reported in the literature to mimic colon cancer. Patients can present with symptoms almost identical to colon cancer. We present an exemplary case of a woman who was found to have a mass on conventional colonoscopy. Virtual colonoscopy was instrumental in characterizing the obstructive sigmoid mass. A biopsy of the mass revealed sigmoid endometriosis.

The Dementia Caregiver—A Primary Care Approach

Caring for loved ones with dementia is challenging and stressful for family members who have to provide the home care. The responsibility takes a huge physical, emotional, and financial toll on the caregivers, which is known as caregiver burden. The survival and quality of life of the dementia patient have been shown to be related to the well-being of the caregiver. An overwhelmed caregiver can result in premature institutionalization and increased health-care utilization, by both the patients and the caregivers. The physician should periodically assess caregivers for the level of perceived burden, presence of depression and anxiety, social support, behavioral problems in the care recipient, and coping strategies and help the patient and caregiver with advance care planning. Strategies that meld support, education, and practical counseling about common caregiving stresses and community resources seem to mitigate caregiver burden and depression.

Large Colonic Lipoma Mimicking Colon Cancer and Causing Colonic Intussusception

Large Colonic Lipoma Mimicking Colon Cancer and Causing Colonic Intussusception

Angiodysplasia Mimicking Colon Cancer: Colonoscopy, Double Contrast Barium Enema, and CT Findings

WEB This is a Web exclusive article. astrointestinal angiodysplasia is thought to be one of the most common causes of lower gastrointestinal bleeding in the elderly. It is also the most common vascular abnormality of the gastrointestinal tract. Lesions in the large bowel occur most often in the right colon [1]. Endoscopy and angiography are the most common methods of diagnosing angiodysplasia. Other diagnostic tools include double-contrast barium enema, CT angiography, and radionuclide scanning. In rare circumstances, an angiodysplastic lesion may present as a submucosal hematoma due to chronic colonic bleeding. We report a rare case of angiodysplasia that presented with a sigmoid polypoid lesion (hematoma) with surrounding colonic wall ulceration. This lesion was difficult to differentiate from colon cancer on double-contrast barium enema, colonoscopy, and CT images. Postoperative findings confirmed the diagnosis of sigmoid angiodysplasia.

Chronic Colonic Ischemia Mimicking Colon Cancer and Presenting as a Recurrent Mass

Ischemic colitis typically presents as an acute disease with bleeding, diarrhea, and abdominal pain. Endoscopic characteristics, include ulceration and inflammation. We present a case of a patient undergoing a screening colonoscopy found to have a recurrent large cecal mass found to be due to chronic ischemia of the colon. A 60 year old asymptomatic Hispanic woman with no significant medical history presented for a screening colonoscopy. She denied abdominal pain, hematochezia, diarrhea, and weight loss. She denied taking any medications. Physical and laboratory examination were within normal limits. Colonoscopy revealed a 3 cm polypoid mass in the cecum with no surrounding edema or mucosal hemorrhage. Multiple biopsies were taken. Histologic evaluation revealed classic changed of chronic ischemia. The patient was managed conservatively. Repeat Colonoscopy three months later showed interval resolution of the polypoid mass in the cecum. Six months later she was admitted with right lower quadrant dull aching abdominal pain. CT scan showed mass in the cecum and proximal ascending colon. Colonoscopy done showed a recurrent mass in the cecum and proximal ascending colon with edema and ulceration. Multiple biopsies were taken and revealed ischemic colitis. Mesenteric angiography was normal. Hematology evaluation failed to reveal a coagulopathy. The patient improved and has remained well. Ischemic colitis is a distinct subtype of ischemic bowel disease most often limited to the superficial mucosa. Colonoscopy typically identifies ulceration, pseudopolyps, hemorrhagic nodules, submucosal bleeding, cyanotic or necrotic mucosa with ulceration. Often there is a segmental distribution with abrupt transition between injured and normal mucosa. Although ischemic colitis may present with polypoid lesions, this is the unique case of ischemic colitis presenting as a large recurrent colonic mass.