Diffuse colon cancer with tumor thrombus in the portal vein

At the Focal Point...

DIFFUSE COLON CANCER WITH TUMOR THROMBUS IN THE PORTAL VEIN

A

C

B

D

A 64-year-old woman was seen with a chief complaint of abdominal distension. Laboratory studies included negative results for hepatitis B virus antigen and antibody, hepatitis C virus antibody, and VOLUME 55, NO. 2, 2002

E tumor markers. Abdominal US showed portal vein thrombosis with ascites. Superior mesenteric artery angiography disclosed a hypervascular lesion in the region of the transverse colon (A). Barium contrast GASTROINTESTINAL ENDOSCOPY

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radiography demonstrated marked narrowing in the distal transverse colon, splenic flexure, descending, and distal sigmoid colon (B). At colonoscopy, the mucosa in the sigmoid and descending colon was edematous and the appearance suggested a submucosal, tumor-like lesion (C, D). Inflammatory bowel disease and lymphoma were considered in the differential diagnosis. However, histopathologic evaluation of colonic biopsy specimens showed well-differentiated adenocarcinoma (E, H&E, orig. mag. ×10), and a diagnosis of diffuse colon cancer with portal vein tumor thrombosis was made. Despite chemotherapy, the patient died on the 51st hospital day.

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GASTROINTESTINAL ENDOSCOPY

Hiroshi Nakase, MD, PhD Chiharu Kawanami, MD Toshiyuki Itoh, MD, PhD Kazuichi Okazaki MD, PhD Tsutomu Chiba, MD, PhD Graduate School of Kyoto University Kyoto, Japan Toshinao Itani, MD Jun Mimura, MD Toshihiko Kawasaki, MD Hideshi Komori, MD Nishi Kobe Medical Center Hyogo, Japan doi:10.1067/mge.2001.118963

VOLUME 55, NO. 2, 2002