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Tuesday, January 29, 2013

Recurrent Mucinous Adenocarcinoma of colon



Presentation


26 years old lady presented in August 2010 with complaints of lower abdominal pain off and on for 1 year. She also had H/o 2-3 kg weight loss in three months. There was no h/o loss of appetite, no h/o bleeding P/R, No h/o altered bowel habit

CECT scan abdomen showed large polypoidal mass in ileoceacal  region. She underwent
  • Right hemicolectomy in August 2010.  H/P examination revealed  
  • Moderately differentiated mucinous adenocarcinoma pT3N1Mx
  • Tumor was reaching up to serosa, LN mets present (7/13)
  • Proximal & distal resection margin was free from tumor. After this the patient received chemotherapy from September 2010 to march 2011
  • During follow up of 26 months patient was normal clinically. PET-CECT scan done 6 monthly and serum-CEA done 3 months intervals was normal. During follow up September 2012 serum-CEA rose to 8.6 . PET-CECT scan, UGI endoscopy, Colonoscopy Normal, Repeat in December 2012 s-CEA was 17.0.  PET-CECT scan showed FDG avid heterogenous enhancing hypodense lesion in relation of right adnexa

Patient underwent a Diagnostic Laparoscopy on19th December 2012, Operative findings were
  • Right pelvic 5x4x4 cm tumor covered with jelly like material and was adhered to right pelvic wall   and right ovary + fallopian tube
  • Uterus and left ovary was appear normal
  • Bowel and peritoneum was normal with no ascites
  • Excision of tumor with normal margin was done




Main Issues in this case
  • Young age
  • Mucinous Adenocarcinoma of colon
  • Recurrence in pelvis after 28 months
  • Recurrent tumor excised
  • S-CEA became normal after 3 weeks of follow up 
  • We require suggestions for further planning regarding
o       Further management and
o       Follow up



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