PMC6617874_01
FDG-PET scan with an extensive right upper lobar and mediastinal mass in keeping with primary non-small-cell lung cancer (arrow). Intense heterogenous uptake in the sigmoid colon (white arrow), which could represent a synchronous malignancy or complication secondary to diverticular disease.
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fig1
This was suspicious for a metastatic deposit or a complication secondary to diverticular disease (Figure 1).
Axial CT highlighting a focal area of thickening in the wall of the sigmoid colon with surrounding diverticula.
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fig2
A CT scan was performed which demonstrated a focal area of thickening of the sigmoid colon (Figure 2); however, given the recent colonoscopy findings, the possibility of malignancy was deemed less likely in this situation.
Sagittal CT highlighting a hyperdense tubular foreign object in the sigmoid colon (arrow), in addition to displaying a mass-like thickening of the sigmoid colon.
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A CT scan demonstrated circumferential thickening of the bowel wall in the sigmoid colon and a suspicious-looking intraluminal tubular structure distal to this, suspicious for a foreign body (Figures 3 and 4).
Axial CT scan. Arrow points out a cross-sectional image of the foreign body in question. Meanwhile, the area outlined represents the mass-like thickening of the sigmoid colon proximal to the foreign body.
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fig4
A CT scan demonstrated circumferential thickening of the bowel wall in the sigmoid colon and a suspicious-looking intraluminal tubular structure distal to this, suspicious for a foreign body (Figures 3 and 4).
FDG-PET scan of our patient, following two weeks of serial radiological imaging, to monitor the foreign body. An intensely FDG-PET avid mass in the sigmoid colon was highlighted on imaging (arrow).
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A repeat FDG-PET-CT scan was conducted, revealing an intensely FDG avid mass in the midsigmoid colon (Figure 5).
Image of chicken bone retrieved with flexible sigmoidoscopy. The bone measured 6 cm in length with no apparent sharp edges.
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This revealed a chicken bone impacted in the sigmoid colon (Figure 6).
Coronal CT of the abdomen and pelvis highlighting an intramural sigmoid mass (a). Furthermore, the appearance of abscess transformation was noted, with gas locules evident (b).
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A further CT scan raised concern that this mass had become an intramural abscess with images displaying some gas locules within it (Figure 7).
Image of resected sigmoid mass, following laparotomy. Histopathology confirmed the mass to be metastatic lung cancer.
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She underwent a resection of this sigmoid mass along with a contiguous segment of the bladder (Figure 8).
Photomicrograph of patient's resected sigmoid mass. (a) H&E staining displaying atypical tumour cells and areas of necrosis under 100x magnification. (b) Specimen under 100x magnification with CK7 staining outlining a diffuse distribution of tumour cells.
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fig9
Histopathology confirmed that this mass was a large deposit of metastatic lung cancer (Figure 9).