Case 18-1995

Abstract

A 59-year-old woman was admitted to the hospital because of increasing constipation, abdominal pain, and a rectosigmoid mass.The patient had been well until three months earlier, when pain in the right lower quadrant and constipation developed and gradually worsened; she passed mucus in her stools, without blood. Three weeks before admission colonoscopic examination at the gastrointestinal clinic showed a concentric mass, approximately 8 cm in diameter, in the sigmoid colon, with nearly complete obstruction. A pediatric endoscope was passed into the ascending colon with difficulty. No further abnormalities were observed. It was noted that the mucosa overlying the mass appeared normal. Microscopical examination of six biopsy specimens of the lesion revealed mildly edematous colonic mucosa with patchy eosinophilic infiltration of the lamina propria and glandular epithelium; no eosinophilic abscesses or microorganisms were identified. A barium-enema examination ( Fig. 1), performed with the air-contrast technique, showed a constricting lesion, 8 cm in length, of the distal sigmoid colon with an apple-core appearance; the remainder of the colon appeared normal. A computed tomographic (CT) scan of the abdomen and pelvis (Fig. 2) revealed a right extrarenal pelvis, a calculus (7 by 4 mm) in the upper pole of the right kidney, and another calculus (7 mm) in the lower pole of the left kidney. The rectosigmoid colon was constricted, with diffuse thickening of its wall and strands of soft-tissue density that extended into the pericolonic fat. A heterogeneous, rounded, fat-containing, soft-tissue mass (7 cm in diameter) was contiguous with the rectosigmoid wall. No lymphadenopathy was detected, and the bladder, liver, gallbladder, pancreas, spleen, and adrenal glands appeared normal.During the week before admission, a cough produc-tive of purulent sputum developed, accompanied by low-grade fever and dysuria. Radiographs of the chest disclosed an infiltrate in the right middle lobe and another in the right upper lobe; the right cardiac border was poorly delineated. The urine was normal. A culture of sputum yielded moderate growth of Streptococcus pneumoniae and Branhamella catarrhalis. The patient was admitted to the hospital. The patient was a housewife. She had a five-year history of non-insulin-dependent diabetes mellitus. She had eaten less than usual in recent months and had lost 9.1