Presentation
Abdominal pain since 1 year; vomiting and increased frequency of passing stools since 2 months; fever since 1 day; CEA – 75.78 ng/ml
Patient Data
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Bowel wall thickening noted involving the hepatic flexure of colon, distal ascending colon and proximal transverse colon. Post contrast study shows no significant enhancement.
Intussusception of proximal ascending colon into the lesion noted.
Mild adjacent pericolic fat stranding noted.
Few mesenteric lymph nodes noted.
The above features were suggestive of a neoplastic growth with colo-colic intussusception.
Colonoscopy with biopsy was performed from the growth in proximal transverse colon.
Histopathology report:
Microscopy – sections show a predominantly exophytic tumor composed of pleomorphic columnar cells with hyperchromatic nuclei and moderate amount cytoplasm. These cells are arranged in glandular and villous configuration with pseudostratification. Irregular tubules are seen to infiltrate the muscularis mucosa. Surrounding stroma shows desmoplasia with chronic inflammatory infiltrate and pools of extravasated mucin.
Impression – Histological features suggestive of Adenocarcinoma in a background of villous adenoma.
Patient underwent right hemicolectomy.
Case Discussion
Colonic intussusception are commonly associated with malignant tumors, including primary tumors (adenocarcinoma, lymphoma) and metastases. Colonic intussusception usually presents in a subacute manner with prolonged abdominal pain and constipation.