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Abdomen » Gastrointestinal
Advanced carcinoma of the sigmoid colon
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Author(s) :
Paulo Cegallo
 
Presentation A 59 year old woman presents with complaints of weight loss, an abdominal hypogastric mass and gross haematuria. An ultrasound was performed.
 
 
 
Caption: Transabdominal scan of the pelvis 3 months later
Description: The patient was lost to follow up. She returned 3 months later. This image shows a huge solid mass with focal calcifications in the pelvic cavity. The bladder and the uterus were not seen separate from this mass.
 
 
 
Caption: Transvaginal scan
Description: The solid pelvic mass is noted again measuring about 10 cm. None of the other pelvic organs were visualized separately.
 
 
 
Caption: Colonoscopy image
Description: Colonoscopy revealed a large lobulated mass arising from the rectosigmoid junction.
 
 
 
Caption: Transvaginal scan
Description: This image shows a heterogeneous pelvic mass that infiltrates the anterior uterine wall [marked by arrows]; the uterine architecture is still preserved. The bladder mucosa appears very thickened.
 
Differential Diagnosis Malignant neoplasm of the recto-sigmoid junction
 
Final Diagnosis Malignant neoplasm of the recto-sigmoid junction with infiltration of the adjoining pelvic structures. This was an adenocarcinoma.
 
Discussion This case illustrates features of an advanced bowel malignancy. A discussion on the ultrasound features of bowel malignancy is available [click here to view]
 
Follow Up This patient had no liver metastases and the histology of the lesion revealed moderately differentiated adenocarcinoma. At surgery, the carcinoma was found infiltrating the urinary bladder and the pelvic organs (Dukes`stage D).
 
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