PMC4435290_01
Axial and oblique coronal reformatted CT images of the abdomen and pelvis with oral and intravenous contrast demonstrate a 4.0 x 3.1 x .7-cm mass at the hepatic flexure of the colon, as well as an annular 6.3 x 6.2 x 6.3-cm mass slightly more proximally involving the cecum.
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F1
A contrast CT scan of the abdomen/pelvis revealed two masses: one in the ascending colon and the other in the cecum, with diffuse abdominal lymphadenopathy and several hepatic areas of low attenuation (Figure 1 and Figure 2).
An axial CT image at the level of the liver with oral and intravenous contrast demonstrates a new 2.2-cm hypodense, solid lesion within the periphery of the right lobe of the liver.
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F2
A contrast CT scan of the abdomen/pelvis revealed two masses: one in the ascending colon and the other in the cecum, with diffuse abdominal lymphadenopathy and several hepatic areas of low attenuation (Figure 1 and Figure 2).
H&E stain (20x) of anaplastic glands invading submucosa consistent with well-differentiated adenocarcinoma.
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F3
Biopsies revealed a well-differentiated adenocarcinoma of the ascending colon (Figure 3), and an SCNC of the cecum (Figure 4).
(A) H&E stain (100x) of colonic mucosa infiltrated by small cells. (B) H&E staom (100x) of small round cells with abundant nucleus and scanty cytoplasm. (C) Immunohistochemical stain positive for neuron specific enolase (40x). (D) Immunohistochemical stain positive for synaptophysin (40x).
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F4
Biopsies revealed a well-differentiated adenocarcinoma of the ascending colon (Figure 3), and an SCNC of the cecum (Figure 4).
Large mass: 8 x 6 x 5 cm; 7 cm to S mass, 10 cm to ileal margin. Small mass: 4 x 3 x 1 cm; 7 cm to D margin.
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F5
Due to progressive obstructive symptoms and uncontrolled bleeding, the patient underwent right hemicolectomy (Figure 5) with lymph node dissection revealing 18 of 28 positive nodes for adenocarcinoma.