Invasive Moderately-Differentiated Mucinous Adenocarcinoma Incidentally Identified in Perforated Acute Diverticulitis With Abscess Formation
DOI:
https://doi.org/10.17140/PLMOJ-1-106Keywords:
Colorectal, Adenocarcinoma, Diverticulitis, Perforation, Pericolic abscessAbstract
Colonic adenocarcinoma rarely arises within a diverticulum. As illustrated in this case report,
such an occurrence presents difficulties in diagnosis, posed by the overlap of radiological findings
in diverticulitis and adenocarcinoma and the potential absence of luminal lesion. Here we
present a 77-year-old male with acute left lower abdominal pain, fever and leukocytosis. Computarized
tomography (CT) imaging revealed extensive colonic diverticulosis, with sigmoid
colon wall thickening, extraluminal air and a pericolic abscess. No enlarged lymph nodes were
detected. The clinical diagnosis was acute sigmoid diverticulitis with micro-perforation and abscess
formation. Partial sigmoidectomy was performed and diverticulitis confirmed; no tumor
was identified in the resected colon. However, fragments of mucinous adenocarcinoma were
incidentally recognized in the pericolic abscess contents. Immunohistochemical (IHC) studies
supported a primary colonic adenocarcinoma, warranting further clinical workup. A subsequent
distal sigmoidectomy revealed moderately-differentiated mucinous adenocarcinoma invading
through the visceral peritoneum, and arising in a low-grade mucinous neoplasm within a diverticulum.
The case illustrates that in a patient with diverticulitis and no evidence of a luminal
neoplasm, the unexpected finding of adenocarcinoma in the resected bowel may be attributable
to adenocarcinoma arising within a diverticulum.
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