Synchronous colorectal carcinomas

Case contributed by Dr Bruno Di Muzio

Presentation

Patient presents in the emergency department with signs of bowel obstruction.

Patient Data

Age: 65 years
Gender: Male

CT Abdomen and pelvis (selected images)

CT

There is small and large bowel obstruction due to a segment of wall thickening causing colonic stricture at the splenic flexure; there are associated fat stranding and prominent regional lymph nodes. The upstream distension of the colon reveals a mass lesion in the right colonic flexure, also suspicious for malignancy. 

Diagram illustrative of the findings

Diagram

Arrows pointing the colonic flexure abnormalities.

Case Discussion

The patient underwent surgery that confirmed both lesions to be malignant. Total colectomy was performed and the pathological diagnosis was adenocarcinoma.

Synchronous colorectal cancers are characterized by the presence of others distinct tumoral foci at diagnosis, intra-operatively, or within 6 months of the resection of the primary lesion. After the 6 months, a new distinct colorectal cancer is called metachronous 1.

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