Colorectal carcinoma - caecal
Iron deficiency anaemia for investigation.
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A 6 cm mass is noted arising from the caecum with pericolic soft tissue stranding extending into the mesenteric fat from the colon. A large 18 mm lymph node is noted in the adjacent mesentery. There is no retroperitoneal or pelvic lymph node enlargement and no free fluid.
No focal liver lesions. No focal abnormalities in the spleen pancreas or adrenals. A small cyst is noted in the right kidney. The kidneys are otherwise normal in appearance.
The patient went on to have a right sided colectomy.
A right hemicolectomy specimen comprising terminal ileum (55mm long x 25mm diameter), appendix (45mm long x 5-8mm diameter), caecum and ascending colon (180mm long x 45-65mm in diameter). In the caecum, 15mm from the ileocaecal valve, there is a fungating circumferential tumour, 60mm long x 100mm circumference x 30mm in height, with approximately 70% luminal stenosis. It is 120mm
from distal margin. On section the tumour is tan, soft and glistening. it invades into the pericolic fat. There is focal retraction in the serosa. Multiple lymph nodes are found, ranging from 3mm to 20x20x15mm.
Sections show a moderately differentiated adenocarcinoma which invades through the muscularis propria into the pericolic fat. The tumour has prominent mucinous differentiation. Tumour is located in the right colon and abuts the ileocaecal valve but no definite extension into the terminal ileum is seen. There is associated tubulovillous adenoma with moderate to severe dysplasia. Sections through the appendix are unremarkable. Sections at the proximal and distal resection margins are unremarkable. One of 21 lymph nodes contain metastatic adenocarcinoma which is predominantly mucin. There is a second soft tissue deposit of mucin present which measures 3mm in maximal dimension.
Right colon: Moderately differentiated mucinous adenocarcinoma arising in caecum. Tumour invades through muscularis propria focally into pericolic fat. Tumour appears completely excised.
No angiolymphatic involvement.
One of 21 lymph nodes contain metastatic adenocarcinoma. One 3mm soft tissue deposit of metastatic tumour is present in the mesentery which is entirely mucin.
T3 N1 M0.