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Case Presentation: Mucinous Adenocarcinoma of Cecum

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70F presented 3/24/06 with increasing abdominal pain, distension and weight loss ... calcified mass in L adnexa, cholelithiasis, obstruction secondary to 8.5 x 11 ... – PowerPoint PPT presentation

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Title: Case Presentation: Mucinous Adenocarcinoma of Cecum


1
Case PresentationMucinous Adenocarcinoma of
Cecum
  • Susanna L. Matsen
  • Sinai Hospital
  • April 20, 2006

2
Case Presentation
  • 70F presented 3/24/06 with increasing abdominal
    pain, distension and weight loss for several
    months acutely hematemesis, hematuria, no bowel
    movement x 5 days
  • PMH IDDM, hypercholesterolemia, osteoarthritis
  • Physical exam icteric sclera, jaundice,
    abdominal distension with voluntary guarding,
    tender RLQ with large palpable abdominal mass

3
Case Presentation
  • Labs total bilirubin 7.8 (direct 5.6), alkaline
    phosphatase 868, WBC 14.3, CEA and CA 19-9 in 60s
  • CT scan omental caking, calcified mass in L
    adnexa, cholelithiasis, obstruction secondary to
    8.5 x 11 cm pelvic mass no liver or lung mets

4
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5
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6
Case Presentation
  • Pre-op ERCP with sphincterotomy and clearage of
    CBD stones ( CBD and common hepatic duct
    moderately dilated)
  • CT-guided biopsy mucinous adenocarcinoma-
    ovarian vs. GI
  • Plan operative debulking to improve quality of
    life
  • 4/5/06 underwent subtotal abdominal colectomy,
    Hartmanns pouch, end-ileostomy, total abdominal
    hysterectomy, B oophorectomy, cholecystectomy

7
Case Presentation
  • Intraoperative findings
  • Extensive omental caking
  • 12 x 8 x 3 cm mass leading to bowel obstruction
  • Tumor along L hemidiaphragm
  • Pathology T3M2N1 mucinous adenocarcinoma with
    cecal primary
  • lymphatic and vascular invasion, 5/8 lymph
    nodes, B ovaries, uterus, transverse colon,
    sigmoid and gallbladder with metastatic disease

8
Mucinous AdenocarcinomaEtiology
9
Kang et al 16,991 patients with Mucinous
Adenocarcinoma, 10 years of SEER National Cancer
Registry
  • Accounts for 10-15 of all colorectal
    adenocarcinomas
  • 147,000 new colorectal CA in U.S. in 2004
  • A subtype in which gt 50 tumor composed of mucin
  • Most commonly located in R colon (49.9)

Kang H et al. Dis Colon Rectum 2005481161-8.
10
Mucinous AdenocarcinomaPathology
11
Kang et al Results
  • Mucinous slightly more common in women (53.4)
  • 5.5 per 100,000
  • Survival rate similar to adenocarcinoma when
    controlling for all variables

12
Kang et al Results
13
Kang et al Results
14
Russo A et al 3,583 colorectal cancer patients
from 25 research groups in 17 countries
15
Russo A et al., J Clin Onc 200523(30)7518-28.
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