PMC7492975_01
Right ascending mass in ascending colon CT. (a) (Arrows) colo-colonic intussusception with associated submucosal edema. (b) Right colonic mass measuring approximately 7 cm.
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The patient underwent computed tomography (CT) of the abdomen and pelvis with intravenous contrast, which demonstrated marked irregularity of the right ascending colon and sigmoid with heterogeneous enhancing right colonic mass (~7 cm) with a few small adjacent lymph nodes (Figure 1).
Images from colonoscopy demonstrating pedunculated large mass in the cecum.
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She underwent follow-up colonoscopy that demonstrated a nearly obstructing pedunculated mass with malignant appearance in the right ascending colon near the cecum (Figure 2), a 10 mm sessile polyp in the descending colon, and moderate diverticulosis of the left colon.
Gross pathologic specimen demonstrating a large tumor.
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Due to the size of the obstructing mass with risk of colon perforation, the patient underwent exploratory laparotomy with right hemicolectomy and reanastomosis (Figure 3).
(a) Uninvolved colon from the colectomy specimen with minimal reactive changes and no significant acute or chronic inflammation (100x magnification). (b) Colon mass from the colectomy specimen showing poorly differentiated invasive adenocarcinoma with superficial ulceration, sheet-like architecture, and minimal gland formation undermining adjacent reactive colonic epithelium (arrowheads).
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Sections of the uninvolved colon were unremarkable and showed no inflammation or other features suggestive of S. stercoralis infection (Figure 4(a)). Histologic examination of the mass showed sheet-like architecture of the malignant cells with scattered foci of gland formation, consistent with poorly differentiated adenocarcinoma (Figure 4(b)).