Pathology and Laboratory Medicine
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Visual summary · Pathology and Laboratory Medicine

Invasive Moderately-Differentiated Mucinous Adenocarcinoma Incidentally Identified in Perforated Acute Diverticulitis With Abscess Formation

Mahmoud L. Soliman, Sandra R. Cerda, Huihong Xu

The question

How does colonic adenocarcinoma present when it arises within a diverticulum, and what diagnostic challenges does it pose?

  • The authors report the case of a 77-year-old male patient who presented for the first time with perforated diverticulitis and abscess formation.

What was done

77-year-oldmale patient
4.9×4.6 cmabscess size
16,300 /µLwhite blood cell count
1.7 mg/dLcreatinine level
  • Histopathological analysis of the sigmoid colectomy specimen revealed a mucinous adenocarcinoma that eluded the computarized tomography (CT) imaging.
  • In this article, the authors report in detail the clinical scenario of this patient and review the literature for comparable cases and the current diagnostic practices.

Key findings

Finding 1 of 4
4.9×4.6 cm
adjacent abscess identified by CT

A CT scan revealed extensive colonic diverticulosis, sigmoid colon wall thickening, extraluminal air, and a 4.9×4.6 cm abscess adjacent to the colon.

Finding 2 of 4
0.9 cm
tumor greatest dimension

A subsequent distal sigmoid colectomy revealed a moderately-differentiated mucinous adenocarcinoma measuring 0.9 cm in greatest dimension.

Finding 3 of 4
pT4a, pN0
AJCC Pathological Staging 7th edition

The tumor was classified according to the American Joint Committee on Cancer Pathological Staging 7th edition as pT4a, pN0.

Finding 4 of 4
six days
time to death from presentation

Unfortunately, the patient died within six days of presentation to our hospital from septicemia as a complication of perforated diverticulitis.

Why it matters

  • The case illustrates that in a patient with diverticulitis and no evidence of a luminal neoplasm, unexpected adenocarcinoma in the resected bowel may arise within a diverticulum.

How to cite

Mahmoud L. Soliman, Sandra R. Cerda, Huihong Xu. Invasive Moderately-Differentiated Mucinous Adenocarcinoma Incidentally Identified in Perforated Acute Diverticulitis With Abscess Formation. Pathology and Laboratory Medicine. 2016;1(2):32-36. https://doi.org/10.17140/plmoj-1-106

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