Incidental colonic carcinoma

Case contributed by Dr Yair Glick

Presentation

Left leg weakness, ipsilateral hypoesthesia in the L5-S1 region - radiculopathy?

Patient Data

Age: 65 years
Gender: Female

CT lumbar spine

CT

L4-L5: diffuse disc bulge, exerting mild pressure on the thecal sac.
L5-S1: calcified medial disc herniation (wide protrusion), tangential to the thecal sac. Bilateral osseous narrowing of neural foramina.

Incidental findings:
Concentric wall thickening in descending colon 7.5 cm in length. From its mesenteric wall, an exophytic mass measuring 3.0 x 3.0 x 3.1 cm with a lobular border juts out. The mass is surrounded by mild fat stranding and small mesocolic lymph nodes, and blood vessels are seen passing into it.

Colonoscopy

Photo

Ulcerated, easily bleeding mass located 30-35 cm from the anal verge.

Case Discussion

The radiologist reported the incidental finding on the phone. The patient was notified and was given a recommendation for a CECT chest-abdomen-pelvis and a colonoscopy. The CT (not shown) did not reveal any sign of distal spread of disease. Colonoscopy was aborted after the endoscope could not be advanced proximally to the mass.

She underwent a left hemicolectomy and sigmoidectomy.

Pathology:
Colon: (Left colectomy)
Adenocarcinoma 3 cm, well to moderately differentiated, invasive through the muscularis propria to the pericolonic fat, the tumor present at less than 0.1 cm from the radial resection margins. Proximal, distal and rings resection margins free of tumor. No vascular invasion seen.
Lymph nodes: (pericolonic)
Free of tumor, 9 lymph nodes.

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