HighlightsA mobile cecum is not an uncommon congenital anomaly.Acute appendicitis in the presence of mobile caecum may present with atypical abdominal findings.The presence of mobile cecum should be considered in the differential diagnosis of acute abdomen.CT examination may be helpful in establishing the diagnosis in atypical presentation of acute appendicitis.Abdominal computed tomography (CT) should be done in diagnosing acute abdomen.
INTRODUCTION:
Brain metastasis of colon cancer is often accompanied by metastasis to other organs, and the prognosis is poor. However, long-term survival is reported in some solitary brain metastasis cases. We present a case of descending colon cancer with brain metastasis and relatively long survival after surgery.
CASE DESCRIPTION/METHODS:
Having suffered from amnesia, dysgeusia and headache for 2 weeks, a 58-year-old woman visited a nearby hospital. With a projected tumor in the right occipital brain, she was referred and then admitted to our hospital. A CT scan showed a descending colon tumor, while the PET/CT scan showed fluid accumulation in a right brain tumor and a descending colon lesion. An open resection was indicated to remove a 35 × 40 mm brain tumor, followed by colonoscopy 7 days later, with the scope unable to pass through the entire circumferential tumor. Histopathologic diagnosis confirmed moderately and highly differentiated adenocarcinoma of the colon and moderately differentiated adenocarcinoma of the brain. This indicated colon cancer spread to the brain. The patient was treated with total brain irradiation of 30 Gy/10 times. With no evident distant metastases, she underwent left hemicolectomy 27 days after the brain surgery, removing a nearly 2-cm omental nodule neighboring the tumor. The serosa showed that the main lesion (a non-exposed type-2 tumor of 40 × 50 mm) retracted surrounding tissue. It mainly comprised moderately differentiated adenocarcinoma and poorly differentiated adenocarcinoma at the infiltration tip. Vascular invasion into the subserosa (SS) was observed with five lymph node metastases (N2) and adenocarcinoma in omental nodules (P1). Experiencing a good postoperative course and after treatment with chemotherapy, the patient survived 20 months after the brain surgery without evident brain metastasis relapse, despite liver metastasis 7 months after surgery.
DISCUSSION:
Although rare (0.4-1.8%), brain metastases have a high metastasis rate (82%), resulting in a low one-year survival rate after diagnosis (16%) and poor prognosis. However, long-term survival is frequently reported in cases with solitary brain metastasis. Resection is indicated for brain metastasis of colon cancer when life prognosis is longer than several months; excision causes no serious neurological symptoms; and brain metastasis spreads to no other organs or is well controlled. Surgical treatment, therefore, was considered suitable for our patient.
Highlights
Systemic therapy can achieve good treatment outcomes in advanced CRC.
Suitable chemotherapeutics can markedly improve the prognosis of unresectable CRC.
Unresectable CRC can now be treated with systemic chemotherapy instead of BSC.
Introduction: Inflammatory fibroid polyps (IFPs) are rare, benign lesions of the gastrointestinal tract. Their occurrence in the colon is rare. They are often surgically resected for various reasons. Case presentation: A 60-year-old woman presented to our institution. She had a history of gynecologic surgery for cervical cancer at 37 years of age. Colonoscopy was performed by a local doctor and a type I tumor on Bauhin's valve was suspected. Colonoscopy performed by us revealed a pedunculated polypoid tumor with a 20-mm head that was found to have a long stalk in the cecum. It was inferred that the stalk was entering and exiting through the valve since submucosal bleeding was observed. Polypectomy was performed. The histopathological diagnosis was IFP. Colonoscopy performed after 6 months showed no polyp recurrence. Discussion: According to previous reports, the treatment of colonic IFP was surgical in 58% of cases and endoscopic resection was performed in only 23% of cases. The decision to perform surgery was based on various factors, such as polyp size and position, difficulty in diagnosis by biopsy, and patient symptoms. In the present case, we could successfully perform polypectomy before the appearance of symptoms. Endoscopic resection seems to be an appropriate treatment approach due to the benign nature of IFP. The etiology of IFP remains unknown. Conclusion: The decision to perform surgery or endoscopic resection should be done on a case-by-case basis, but we think that a favorable increase in the number of endoscopic resections will occur in the future.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.