Presentation
3-4 kilograms weight loss over 1-2 months. Severe abdominal pain and bloating. Normal gastroscopy.
Patient Data
Impression of abnormal enhancing tissue at the cecal pole, inferior to the ileocecal valve. No small bowel obstruction. Normal appendix. Mild surrounding fat stranding. 13 mm heterogeneous lymph node in the draining ileocolic mesentery. No definite extramural venous invasion. The cecal pole abuts the peritoneum but no evidence of invasion beyond this.
Moderate sigmoid diverticulosis. Normal appearances of the remainder of the large and small bowel.
Normal liver with no focal abnormality.
Normal gallbladder, adrenals, kidneys, pancreas and spleen. A couple of small splenunculi noted around splenic hilum and anterior to the anterior pole.
No concerning peritoneal nodules identified.
No abdominal or pelvic free fluid.
No concerning adnexal mass.
The imaged lung bases are clear.
Mild degenerative changes of the imaged spine. No destructive bony abnormality identified.
Opinion:
Abnormal enhancing tissue at the cecal pole with an enlarged heterogeneous node. The appearances are concerning for primary colonic malignancy with an involved local node.
Case Discussion
The patient proceeded to colonoscopy where a cecal lesion was seen and biopsied. Histopathology confirmed a well differentiated adenocarcinoma.
A subsequent CT chest did not demonstrate any lung metastases (imaging not shown). This was discussed at the local colorectal multidisciplinary team meeting and given a radiological staging of T2N1M0 (TNM 8th edition).
The patient was otherwise fit and a right hemicolectomy is planned for the near future.
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