Presentation
Iron deficiency anemia for investigation.
Patient Data
A 6 cm mass is noted arising from the cecum 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.
Histology
MACROSCOPIC DESCRIPTION:
A right hemicolectomy specimen comprising terminal ileum (55mm long x 25mm diameter), appendix (45mm long x 5-8mm diameter), cecum and ascending colon (180mm long x 45-65mm in diameter). In the cecum, 15mm from the ileocecal valve, there is a fungating circumferential tumor, 60mm long x 100mm circumference x 30mm in height, with approximately 70% luminal stenosis. It is 120mm
from distal margin. On section the tumor 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.
MICROSCOPIC DESCRIPTION:
Sections show a moderately differentiated adenocarcinoma which invades through the muscularis propria into the pericolic fat. The tumor has prominent mucinous differentiation. Tumor is located in the right colon and abuts the ileocecal 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.
FINAL DIAGNOSIS:
Right colon: Moderately differentiated mucinous adenocarcinoma arising in cecum. Tumor invades through muscularis propria focally into pericolic fat. Tumor appears completely excised.
No angiolymphatic involvement.
One of 21 lymph nodes contain metastatic adenocarcinoma. One 3mm soft tissue deposit of metastatic tumor is present in the mesentery which is entirely mucin.
T3 N1 M0.