Presentation
Mild abdominal pain and change in bowel habits with rectal bleeding for two months.
Patient Data
Asymmetrical circumferential mural thickening of a 6-7 cm long segment of the proximal descending colon/splenic flexure. Mild fat stranding, vascular congestion and a few small subcentimeter lymph nodes around the affected splenic flexure. No evidence of bowel obstruction is seen. Morphology of the rest of the bowel is unremarkable. No evidence of distant metastasis.
Small left adrenal adenoma and a few simple renal cortical cysts; otherwise, the morphology of the solid abdominal viscera is unremarkable. A small fat density is seen in the cecum adjacent to the ileocecal valve (lipomatosis of the ileocecal valve).
Case Discussion
Tumor markers: CA 19.9=42 (≤37 U/ml), CEA=4.9 (<5.0ng/ml)
Colonoscopy: Ulcerated mass in the descending colon, 45-50 cm from the anal verge.
Procedure: Radical transverse colectomy with left hemicolectomy:
Histopathology: Mucinous (colloid) adenocarcinoma, (low-grade). The tumor measures 7 cm in the greatest dimension. Additional dimensions are 5 x 1.5 cm. Tumor invades through the muscularis propria to the pericolonic fat. All margins are negative. No metastasis is seen in the submitted 14 regional lymph nodes (0/14).
Comment: The tumor is classified as pT3, pN1c, pMx because there are multiple deposits in the pericolonic fat in the subserosa without regional lymph nodes infiltration.