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• W2921909601 abstract "There has been extensive debate in the literature whether mucinous histology in colorectal cancer is considered a negative prognostic factor in young patients with regards to 5-year disease free survival. This is important especially considering that American Cancer Society guidelines now recommend that average-risk adults aged 45 years and older undergo regular screening. We present a case of a 45-year-old Caucasian female who presented with cramping abdominal pain for 1 week with nausea and vomiting. She reported lifelong history of irregular bowel movements with alternating loose stools and prolonged periods (sometimes weeks) of constipation, which led her to be diagnosed with IBS in her twenties. Two years ago she noticed decreasing caliber in her stools over time, which she attributed to her IBS, but denied blood in stool or weight loss. Physical exam was significant only for mild tenderness to palpation in the right lower quadrant and mild abdominal distension. Labs were unremarkable and showed hemoglobin 13.4, WBC 8.9, BUN 7, creatinine 0.80, lactic acid 0.8, CEA 2.3. Computed tomography (CT) scan of abdomen/pelvis showed constricting mass in transverse colon with proximal dilation of ascending colon up to 7.6 cm in diameter. CT thorax showed no pulmonary metastases. Gastroenterology was consulted and colonoscopy was deferred due to risk of cecal perforation. General surgery was consulted and did exploratory laparotomy, extended right colectomy, mobilization of hepatic flexure, partial omentectomy, and wound VAC placement. Biopsy of transverse colon showed Grade 2 moderately differentiated adenocarcinoma with mucinous differentiation 10-20% and metastatic carcinoma in 7/28 lymph nodes. Immunohistochemical stains for nuclear defective mismatch repair were negative. She agreed to start chemotherapy in Colorado. Considering colorectal cancer in your patient's differential diagnosis and pursing further investigation based on key history, physical exam, lab, and imaging findings is important. IBS patients must be observant of changes in their baseline symptoms and new red flag symptoms. Our patient presented with suspicious changes different from her baseline and was unfortunately found to have metastatic mucinous adenocarcinoma. Clinicians are now finding colorectal cancer, especially mucinous subtype, to be diagnosed at younger ages and early diagnosis is crucial as this determines a patient's prognosis and specific targeted therapy.1660_A Figure 1. High-powered 40x immunohistochemical stains negative for nuclear defective mismatch repair in A) MSH 2 B) MLH1 C) MSH6 and D) PMS2.1660_B Figure 2. Lymph node positive for metastatic mucinous adenocarcinoma at A) 10x magnification and B) 40x magnification.1660_C Figure 3. A) Invasive intramucosal adenocarcinoma highlighting mucin differentiation at 10x magnification and B) 40x magnification. C) High-grade dysplasia and adenomatous changes present at 10x and D) 40x magnification" @default.
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• W2921909601 date "2018-10-01" @default.
• W2921909601 modified "2023-09-26" @default.
• W2921909601 title "Longstanding IBS vs Metastatic Mucinous Adenocarcinoma: A Diagnostic Dilemma" @default.
• W2921909601 doi "https://doi.org/10.14309/00000434-201810001-01660" @default.
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