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Kayano H, Ueda Y, Machida T, Hiraiwa S, Zakoji H, Tajiri T, Mukai M, Nomura E. Colon cancer arising from colonic diverticulum: A case report. World J Clin Cases 2019; 7:1643-1651. [PMID: 31367623 PMCID: PMC6658384 DOI: 10.12998/wjcc.v7.i13.1643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colonic diverticulosis is a common disease, and the coexistence of colonic diverticulosis and colorectal cancer is often seen clinically. It is very rare that colon cancer arises from the mucosa of a colonic diverticulum. When colon cancer arises in a diverticulum and then tends to develop outside the wall, without developing within the lumen, the differential diagnosis from complicating lesions due to colonic diverticulitis is difficult.
CASE SUMMARY A 76-year-old man was admitted to a nearby clinic with a chief complaint of discomfort and urinary frequency. Since a vesicosigmoidal fistula was seen on abdominal computed tomography, he was referred to our hospital. Laparoscopic sigmoidectomy was performed because the various diagnostic findings were diagnosed as a vesicosigmoidal fistula with diverticulitis of the sigmoid colon. However, on histopathological examination, it was diagnosed as a vesicosigmoidal fistula due to colon cancer arising in the diverticulum. Laparoscopic partial resection of the bladder was performed because local recurrence was observed in the bladder wall one and a half years after surgery. It is currently one year after reoperation, but there has been no recurrence or metastasis.
CONCLUSION Colon cancer arising in a diverticulum of the colon should be considered when diverticulitis with complications is observed.
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Affiliation(s)
- Hajime Kayano
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Yusuhiko Ueda
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Takashi Machida
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Shinichiro Hiraiwa
- Departments of Pathology, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Hidenori Zakoji
- Departments of Urology, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Takuma Tajiri
- Departments of Pathology, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Masaya Mukai
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Eiji Nomura
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
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Malignant Polyp in a Colonic Diverticulum: a Rare Cause of Diverticular Hemorrhage. J Gastrointest Cancer 2016; 43 Suppl 1:S104-7. [PMID: 21952946 DOI: 10.1007/s12029-011-9327-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Affiliation(s)
- Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Suntogun, Japan
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Sigmoid colon cancer arising in a diverticulum of the colon with involvement of the urinary bladder: a case report and review of the literature. BMC Gastroenterol 2014; 14:90. [PMID: 24884743 PMCID: PMC4030041 DOI: 10.1186/1471-230x-14-90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 05/07/2014] [Indexed: 12/24/2022] Open
Abstract
Background Colon cancer can arise from the mucosa in a colonic diverticulum. Although colon diverticulum is a common disease, few cases have been previously reported on colon cancer associated with a diverticulum. We report a rare case of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder, which presented characteristic radiographic images. Case presentation A 73-year-old man was admitted to our hospital for macroscopic hematuria. Computed tomography and magnetic resonance imaging revealed a sigmoid colon tumor that protruded into the urinary bladder lumen. The radiographs showed a tumor with a characteristic dumbbell-shaped appearance. Colonoscopy showed a type 1 cancer and multiple diverticula in the sigmoid colon. A diagnosis of sigmoid colon cancer with involvement of the urinary bladder was made based on the pathological findings of the biopsied specimens. We performed sigmoidectomy and total resection of the urinary bladder with colostomy and urinary tract diversion. Histopathological findings showed the presence of a colovesical fistula due to extramurally growing colon cancer. Around the colon cancer, the normal colon mucosa was depressed sharply with lack of the muscular layer, suggesting that the colon cancer was arising from a colon diverticulum. Conclusion The present case is the first report of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder. Due to an accurate preoperative radiological diagnosis, we were able to successfully perform a curative resection for sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder.
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Xu J, Yang L, Guo Y, Zhao D, Wang L, Bai L. Perforation of sigmoid diverticulum following endoscopic polypectomy of an adenoma. BMJ Case Rep 2010; 2010:bcr07.2009.2077. [PMID: 22461856 PMCID: PMC3029913 DOI: 10.1136/bcr.07.2009.2077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Colonic polyps or carcinomas located within a colonic diverticulum are very rare phenomena. There are a few reports in the literature describing adenocarcinoma arising within colonic diverticulum. Endoscopic resection of the polyp poses a risk of perforation because of the lack of muscular coats in the diverticulum. Therefore, special care should be taken in the treatment of such patients.
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Affiliation(s)
- Jing Xu
- Southern Medical University, Department of Gastroenterology in Nanfang Hospital, Guangzhou, Guangdong Province, 510515, China
| | - Lisheng Yang
- Nanfang Hospital, Southern Medical University, Huiqiao Building, Guangzhou, Guangdong Province, 510515, China
| | - Yu Guo
- Nanfang Hospital, Southern Medical University, Huiqiao Building, Guangzhou, Guangdong Province, 510515, China
| | - Donghui Zhao
- Nanfang Hospital, Southern Medical University, Huiqiao Building, Guangzhou, Guangdong Province, 510515, China
| | - Li Wang
- Nanfang Hospital, Southern Medical University, Huiqiao Building, Guangzhou, Guangdong Province, 510515, China
| | - Lan Bai
- Nanfang Hospital, Southern Medical University, Huiqiao Building, Guangzhou, Guangdong Province, 510515, China
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van Beurden A, Baeten CIM, Lange CPE, Doornewaard H, Tseng LNL. Adenocarcinoma Arising within a Colonic Diverticulum in a Patient with Recurrent Diverticulitis. Clin Med Oncol 2008; 2:529-31. [PMID: 21892327 PMCID: PMC3161636 DOI: 10.4137/cmo.s693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In 2006, while admitted in our hospital for surgical treatment of recurrent diverticulitis, a 54-year-old man was found to have an adenocarcinoma arising within a colonic diverticulum. Computed tomography, during this episode of diverticulitis, showed a thickened wall of the sigmoid and inflammatory induration of the pericolonic fat. Colonoscopy could be performed up to no more then 25 cm from the anus due to mucosal edema. A sigmoid resection was performed. Histopathological examination of the resected specimen showed an inflamed diverticulum with a submucosal adenocarcinoma of the intestinal type within its wall. The surrounding flat colonic mucosa was not involved by the cancerous process. Due to lymph node involvement the patient received adjuvant chemotherapy and remained disease free during follow up.
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Affiliation(s)
- A van Beurden
- Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands
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Brahmania M, Kanthan CS, Kanthan R. Collision tumor of the colon--colonic adenocarcinoma and ovarian granulosa cell tumor. World J Surg Oncol 2007; 5:118. [PMID: 17949502 PMCID: PMC2164962 DOI: 10.1186/1477-7819-5-118] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 10/20/2007] [Indexed: 12/19/2022] Open
Abstract
Background Collision tumors of the colon are rare. We report the first case, to our knowledge in the English literature, of a collision tumor composed of a colonic adenocarcinoma arising in a sigmoid diverticulum coexisting with a recurrent ovarian granulosa cell tumor. Case presentation A 64-year old woman presented with small bowel obstruction and a large, heterogenous, solid/cystic serosal based pelvic mass consistent with a gastrointestinal stromal tumor on imaging. Her significant past history 16-years ago included a bilateral salpingo-oophrectomy with hysterectomy. Surgical removal of the mass and pathological examination revealed the presence of a colonic adenocarcinoma arising in a large sigmoid diverticulum coexistent with a second neoplastic tumor phenotype; confirmed to be a delayed recurrent ovarian granulosa cell tumor. Though coexistent, the two tumor phenotypes respected their boundaries with no diffuse intermingling or transition between them. She developed lung metastases from the recurrent ovarian tumor within 6 months and died within a year of follow-up. Conclusion Collision tumors of the colon are rare. This is the first case reported of a collision tumor composed of adenocarcinoma colon and recurrent granulosa cell tumor representing an example of two independent tumors in a unique one-on-another collision. Clinical awareness and recognition of such tumors are important as they will dictate appropriate treatment strategies dependent on the individual biological aggressiveness of each of the tumor components. Our report highlights the need for histopathologists, surgeons, and oncologists to be aware of the rare possibility of collisions tumors. As seen in our case, the delayed recurrence of granulosa cell tumor of the ovary sixteen years after the initial presentation was the key determining factor in tumor recurrence, tumor progression, and tumor metastasis within three months, which ultimately lead to accelerated death within a year of clinical presentation. Thus accurate identification and recognition of the second neoplasm is important as prognosis and survival may be determined by this component as seen in our index case.
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Affiliation(s)
- Mayur Brahmania
- Department of Pathology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, Canada.
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Soran A, Harlak A, Wilson JW, Nesbitt L, Lembersky BC, Wienad HS, O'Connell MJ. Diverticular Disease in Patients with Colon Cancer: Subgroup Analysis of National Surgical Adjuvant Breast and Bowel Project Protocol C-06. Clin Colorectal Cancer 2006; 6:140-5. [PMID: 16945170 DOI: 10.3816/ccc.2006.n.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Similar epidemiologic characteristics suggest a common etiology for colon cancer (CC) and diverticular disease of the colon (DD). The relationship between the 2 diseases is still unclear, and the impact of DD in patients diagnosed with CC on disease-free survival (DFS) and overall survival (OS) is unknown. National Surgical Adjuvant Breast and Bowel Project (NASBP) protocol C-06 is a clinical trial comparing oral uracil/tegafur/leucovorin with 5-fluorouracil/leucovorin in patients with resected stage II/III carcinoma of the colon. PATIENTS AND METHODS The NASBP enrolled 1,608 patients who had undergone potentially curative resection for stage II/III colon cancer from 256 medical sites between February 14, 1997, and March 31, 1999. RESULTS Pathology reports from 1561 eligible patients retrospectively reviewed for the presence of DD revealed that 160 (10.2%) had this disease. The median ages of patients with CC and DD and without DD were 67 and 61 years, respectively (P < 0.05). The majority of patients were white, and Hispanic patients were better represented in the group with DD (P < 0.05). Colon cancer was located in the rectosigmoid in 46.88% of patients with DD and in 31.92% of patients without DD (P < 0.05). A baseline diagnosis of DD made no significant contribution to DFS or OS without adjustment for confoundin factors (P = 0.2 and P = 0.32, respectively) or adjusted for Dukes classification and age (P = 0.49 and P = 0.68, respectively). CONCLUSION The prevalence of DD in patients diagnosed and treated for CC was 10.2%. Patients with CC with and without DD differed from each other with respect to age, tumor location, and ethnicity. There was no negative impact of having DD on DFS and OS in patients treated for stage II/III CC.
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Affiliation(s)
- Atilla Soran
- The National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers, USA.
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Wakahara T, Tsukamoto T, Kitamura S, Watanabe A, Tsujimura T, Nakamura Y, Toyokawa A, Onishi N, Hamabe Y, Mukai H, Teramura K. Metastatic colon cancer from intrahepatic cholangiocarcinoma. ACTA ACUST UNITED AC 2006; 12:415-8. [PMID: 16258812 DOI: 10.1007/s00534-005-0991-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 04/30/2005] [Indexed: 11/30/2022]
Abstract
A 62-year-old man had been followed because of an elevated serum level of carcinoembryonic antigen without the detection of any cancer lesions. However, there was a sudden increase in the serum level of carcinoembryonic antigen, and abdominal imagings showed a hepatic tumor with peripheral intrahepatic bile duct dilatation, and a submucosal tumor at the sigmoid colon with intact mucosa. Histopathological findings showed that the hepatic tumor had perineural invasion, suggesting an intrahepatic cholangiocarcinoma, and that the colon tumor infiltrated the submucosa, while its mucosa was intact. Both tumors showed similar pathological features and were positive for cytokeratin 20 and 7. These findings suggested intrahepatic cholangiocarcinoma with metastatic sigmoid colon cancer.
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Affiliation(s)
- Tomoyuki Wakahara
- Department of Surgery, Yodogawa Christian Hospital, 2-9-26 Awaji, Higashi Yodogawa-ku, Osaka 533-0032, Japan
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Barr YR, Brazowski E, Leider-Trejo L. Villous adenoma in a perforated colonic diverticulum. Int J Colorectal Dis 2006; 21:282-4. [PMID: 15703888 DOI: 10.1007/s00384-004-0694-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2004] [Indexed: 02/04/2023]
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