Unusual Presentation of Cancer Colon

Abstract

This patient, a 75-year-old Libyan female, presented to African Oncology Institute with complaints of progressively worsening watery and offensive discharge per vaginam for last 1 month with a history of intermittent episodes of bleeding per vaginam. She was postmenopausal; gravida 14; known hypertensive and diabetic, controlled on treatment; and had a surgical history of cholecystectomy in remote past. On presentation, her cardiorespiratory and abdomen examinations were normal.The pelvic examination revealed a big mass protruding from os whose origin appeared to be cervix. The uterus was irregularly enlarged, mainly in lower segment.Diagnostic workup included ultrasonography pelvis which revealed uterus with thin endometrium and a 5-cm 9 5-cm mass occupying cervix. Sonography of abdomen was remarkable for somewhat edematous and dilated small colon but without any obvious mass or adenopathy. Computerized tomography scan of abdomen and pelvis revealed thick-walled and largely opened vagina which appeared hypodense in comparison to uterus and revealed a growth appearing highly suspicious of neoplastic lesion (Fig. 1). The patient was subjected to examination under anesthesia which revealed a 3-4 cm fungating and friable mass involving entire cervix, and extending to upper part of vagina. Uterus was large and partially mobile. Rectovaginal examination revealed induration of inner one-third of left parametrium while the right parametrium was normal. Rectum was normal with the presence of normal-colored stool. Her CEA and CA 19.9 were within normal limits. A punch biopsy was taken from this cervical mass. Histopathologic examination of this biopsy reported the mass to be well-differentiated papillary adenocarcinoma and appeared to be of endometrial origin. With these findings, the patient was diagnosed as a case of adenocarcinoma uterus and staged IIIA per FIGO classification. The patient was discussed in multidisciplinary oncology committee of the institute and was decided as a candidate for neoadjuvant radiotherapy to be followed by radical hysterectomy.