Presentation
Iron deficiency anemia for investigation. Right lower quadrant pain. No history of PR bleeding. 10 kg loss of weight over 2 months ?malignancy ?cause for anemia.
Patient Data
There is a large necrotic mass circumferentially involving the transverse colon, measuring approximately 12.4 x 7.8 x 7.8 cm (axial x SI). Oral contrast passes through the mass with no evidence of proximal large bowel obstruction.
No discrete enlarged lymph nodes are identified, but there are several lobulated masses adjacent to and continuous with the mass, which may represent engulfed lymphadenopathy.
There are adjacent loops of small bowel which demonstrate mural thickening, at least one of which is contiguous with and inseparable from the inferior margin of the mass. There is no upstream dilatation to suggest obstruction.
There is a well-circumscribed ovoid 21 mm mass indenting the greater curvature of the stomach. This appears to arise extrinsic to the stomach.
Conclusion:
Large neoplastic lesion involving the transverse colon, without evidence of obstruction.
This appearance is suspicious for lymphoma, with a differential of carcinoma.
Extrinsic mass indenting the greater curvature of the stomach may represent a gastrointestinal stromal tumor.
Case Discussion
Transverse colon adenocarcinoma and gastric GIST confirmed at surgery.
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