Perforated mucinous adenocarcinoma of the colon with carcinomatosis

Case contributed by Michael P Hartung
Diagnosis certain


Abdominal pain.

Patient Data

Age: 70 years
Gender: Female

Circumferential, mass-like thickening with multiple calcifications within the mid ascending colon through the hepatic flexure. Perforation of the ascending colon along the anterior aspect with extraluminal stool and gas. Ileocolic adenopathy. Multiple areas of nodularity within the omentum of the lower abdomen and pelvis. Small areas of nodularity within the anterior omentum. Mild thickening of a few loops of distal small bowel, with mildly dilated distal small bowel.

Nonocclusive thrombus in the right common femoral and external iliac veins. 



Specimen "A" - Omentum, biopsy - Metastatic mucinous adenocarcinoma.

Specimen "B" - Terminal ileum and right colon, right colectomy:

- Mucinous adenocarcinoma, right colon, with invasion through muscularis propria to

visceral peritoneum and macroscopic perforation.

- Innumerous tumor deposits.

- Lymph nodes (27), 13 positive for metastatic adenocarcinoma.

- Ileum and colon resection margins, negative for carcinoma

- ileocolitis, predominantly involving ileum, without obvious granulomas.


Case Discussion

This is a dramatic presentation of mucinous adenocarcinoma of the colon. There is a large perforation along the anterior aspect of the ascending colon in the area of masslike thickening which extends to the hepatic flexure. There are several small calcifications associated with the colonic mass, which is a common feature of mucinous adenocarcinoma. There is extraluminal stool and gas. These findings alone make a suspicion for perforation in the setting of malignancy very high.

Additionally, there is ileocolic adenopathy. There are multiple areas of nodularity within the mesentery and omentum, consistent with carcinomatosis. This was confirmed at the time of surgery. There is thickening within the distal small bowel which is most likely related reactive inflammation in the setting of perforation (this is confirmed in the pathology report). This patient had a mucinous adenocarcinoma of the colon pathology, which often can present late with advanced disease, and is less likely to perforate as it is more pliable than nonmucinous adenocarcinoma.

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