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Apple core sign - cancer colon

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Bleeding per rectum and abdominal pain.

Patient Data

Age: 50 years
Gender: Male

Virtual colonscopy revealed: Apple core with constriction of the hepatic flexure lumen.

Axial CT cuts revealed the neoplastic soft tissue mass involving the hepatic flexure significant encroaching upon its lumen, additionally the CT images clearly illustrates the pericolic smudging as well the enlarged peri-colic lymph nodes.

Annotated image

Virtual colonscopy revealed: Apple core with constriction of the hepatic flexure lumen.

Axial CT cuts revealed the neoplastic soft tissue mass involving the hepatic flexure significant encroaching upon its lumen, additionally the CT images clearly illustrates the pericolic smudging as well the enlarged peri-colic lymph nodes.

Case Discussion

  • The apple core sign, also known as a napkin ring sign, is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma
  • CT is the modality most used for staging colorectal carcinoma, with an accuracy of only between 45-77% , able to asses nodes and metastases.
  •  CT colonography is increasing in popularity as an alternative to colonoscopy.

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