Colon cancer

Case contributed by Dr MT Niknejad

Presentation

Abdominal pain and chronic constipation.

Patient Data

Age: 65 years
Gender: Male
CT

Emphysematous changes and multiple thin-walled air-filled cysts, less than 45mm are seen at both lungs more prominent at bases. In addition, a few patchy ill-defined mostly subpleural ground glass opacities are present at both lungs could be suggestive for early stage COVID19 pneumonia. 


The hepatic attenuation value is less than of the spleen, suggesting fatty liver.
A peripheral, dense, spotty enhancing mass, approximately 25mm in diameter, is seen in hepatic segment VII (Couinaud`s nomenclature), on the early post contrast phase. In the equilibrium phase the attenuated areas spread through the mass and filling in. The density of enhancing components is almost the same as that of the aorta in all phases of the CT scan. Additionally, a few thin-walled non-enhanced cysts are present in the liver, less than 33mm.
A 28mm simple cortical cyst is noted in the left kidney. There is also a 40mm para-pelvic cyst in the right kidney.


Circumferential increased wall thickness due to tumoral infiltration is present in the distal descending and proximal of sigmoid colon measuring 7cm in length. Mild surrounding fat stranding and a few small regional lymph nodesobserved. Small lymphadenopathy with SAD of 10mm is also present at para-aortic region.


A 20mm polypoid mass is noted in the right posterolateral aspect of urinary bladder, which shows focal marginal calcifications. Additionally, a 3mm vesical stone is seen. The prostate gland is enlarged.


Degenerative changes as osteophytosis are seen in the lumbar spine.

Case Discussion

Features on CT scan are compatible with:

1. Colon mass (pathology proven adenocarcinoma).
2. Small regional & para-aortic lymphadenopathy.
3. Urinary bladder mass; Further cystoscopy is needed.
4. Prostate enlargement.
5. Hepatic cysts.
6. Hepatic mass; compatible with hemangioma.
7. Fatty liver.
8. Renal cortical & parapelvic cysts.
9. Lung emphysema.
10. Lung focal ground glass opacities; suspected for early stage COVID-19 pneumonia. 

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