Apple core sign (colon)

Case contributed by Dr MT Niknejad

Presentation

Chronic constipation

Patient Data

Age: 65 years
Gender: Female
Barium

On double contrast barium study; dolichocolon is evident. There is short segment stricture with shouldering appearance and apple core sign at proximal of transverse colon suggestive for tumoral infiltration. 

CT

Increased wall thickness due to tumoral infiltration is present at proximal of transverse colon measuring about 8 cm in length and accompanied by a few small regional lymphadenopathies.
The hepatic attenuation value is less than of the spleen, suggesting fatty liver. Additionally, several small hypoattenuating lesion, less than 15 mm, are seen at liver which shows no obvious enhancement on delayed images.
A 60 mm thin-walled cortical cyst with small focal marginal calcification is present at lower pole of left kidney. 
No enhancing solid component or frank septation within (Bosniak 2). Additionally, several subcentimeter simple renal cortical cysts are seen.
Uterus is enlarged and contains a 50 mm fibroid. 
Degenerative changes as osteophytosis are seen at the lumbar spine.
Grade I spondylolisthesis of L4 on L5 is present with bilateral spondylolysis.

Case Discussion

Further colonoscopy evaluation in this patient shows an infiltrative mass at proximal portion of the transverse colon and tissue exam confirms colon adenocarcinoma
Colorectal cancers can be found anywhere from the cecum to the rectum and transverse colon involvement includes about 10% of cases.1
The apple core sign in barium study of colon is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma.2

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