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- Title
COLONIC LATERALLY SPREADING TUMOR, ALWAYS A DIAGNOSTIC CHALLENGE.
- Authors
Luca, Sabina-Gabriela; Petrea, Oana Cristina; Muzica, Cristina; Huiban, Laura; Dimache, Mihaela; Barboi, Oana; Girleanu, Irina; Trifan, Anca; Stanciu, Carol
- Abstract
Introduction. Colorectal cancer is one of the most common malignancies and is still one of the major causes of cancer-related mortality worldwide. Laterally spreading colorectal tumors (LSTs) are nonpolypoid neoplastic lesions with a diameter of at least 10 mm, which typically extend laterally rather than vertically along the interior luminal wall. LTSs have recently received special attention due to the significant degree of dysplasia and the diagnostic and therapeutic challenge that it represents for clinical practice. LTSs can reach impressive sizes, most of them larger than 2 cm and the classification into granular and non-granular is an important characteristic for establishing the degree of dysplasia and choosing the appropiate treatment. Case presentation. A 73-year-old patient with significant cardiovascular (cardiac pacemaker) and metabolic diseases (diabetes mellitus type 2 and morbid obesity), without a history of digestive diseases, was admitted to our department for abdominal pain. At admisson, blood tests revealed a non-specific inflammatory syndrome, liver cytolysis, without signs of cholestasis and moderate anemia. Likewise, carcinoembryonic antigen and CA19.9 were elevated. Plain X-ray ruled out pneumoperitoneum or intestinal obstruction. Abdominal ultrasound revealed multiple hepatic metastases with the largest measuring approximately 75 mm. Upper digestive endoscopy was performed identifying a deep duodenal ulceration suggestive of possible extrinsic invasion, but with a histopathological result of benign ulceration, without tumoral elements. A computed tomography was then performed with exclusion of a pancreatic neoplasia. We decided to perform a colonoscopy that revealed a pseudodepressed flat type LST which was about 2 cm in diameter, located at about 30 cm from the anal verge with slight central depression (0-IIa+IIc). Histopathology report showed a moderately differentiated adenocarcinoma. Discussion. The initial suspicion of diagnosis was neoplasm of pancreas with liver metastases, with a malignant duodenal invasion, diagnosis that was infirmed by the anatomopathological result that obiectivated the benign etiology of the ulcer. The final diagnosis was colonic adenocarcinoma with hepatic metastases. The patient was addressed to Regional Institute of Oncology for oncological treatment. Conclusion. This case offers a broad and multidirectional diagnostic perspective in a patient without significant symptoms and with multiple comorbidities.
- Subjects
METASTASIS; DIGESTIVE system diseases; TYPE 2 diabetes; MORBID obesity; ETIOLOGY of diseases; CARCINOEMBRYONIC antigen
- Publication
Journal of Gastrointestinal & Liver Diseases, 2023, Vol 32, p83
- ISSN
1841-8724
- Publication type
Article