PMC6076219_01
A. Chest X-Ray: Right upper lobe nodule. B. Chest computed tomography which revealed a 2.8cm right upper lobe nodule with speculated margins. C. Abdominal computed tomography which revealed a large soft tissue mass of 4.3 x 3.8 cm in size in the ascending colon.extending from the colonic lumen to the pericolic fat.
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CT revealed a 2.8 cm nodule in the right upper lobe with speculated margins without mediastinal lymph node enlargement (Fig. 1B). Contrast enhanced CT of the abdomen and the head had no findings suggestive of metastatic disease. As there were no abnormal findings at clinical examination we added CT scan for lower abdomen to his scheduled CT surveillance that revealed an ascending colonic mass 4.3 x 3.8 cm extending from the colonic lumen to the pericolic fat (Fig. 1C).
Colonofibroscopy image: A large protruding lesion with central ulceration in the ascending colon.
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Colonfibroscopy revealed a large protruding lesion with central ulceration in the ascending colon (Fig. 2).
A. Poorly-differentiated adenocarcinoma metastatic to the colon [hematoxylin eosin (HE) x 10]. B: Positive immunohistochemical staining for CK 7 (x 10). C: Positive immunohistochemical staining for TTF-1 (x 10).
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Immunohistochemical staining was negative for anti-cytokeratin 20 antibody, positive for anti-pancytokeratin (AE1-AE3) and anti-cytokeratin 7 antibody and only focally positive for anti-TTF-1 antibody, with moderate intensity nuclear staining (Fig. 3).