1/5. Colonoscopic detection of a malignant melanoma metastatic to a tubular adenoma of the colon: report of a case.PURPOSE: Metastasis of a malignant neoplasm to a benign tumor is an infrequent event. adenomatous polyps of the colon have only been reported on three occasions acting as host tumors. We report the first case where a malignant melanoma metastasizing to a tubular adenoma in the colon was detected during colonoscopy. methods: An 85-year-old male with dementia and right hemiparesis presented to the hospital with change of bowel habits, signs and symptoms of anal incontinence, and a perianal ulcer. On physical examination, multiple subcutaneous nodules over his chest and abdominal wall were detected, and laboratory data revealed iron deficiency anemia. A colonoscopy was performed. RESULTS: During colonoscopy, a pedunculated, greenish-brown-colored polyp measuring 2 cm in greatest dimension located in the transverse colon was identified and snared. pathology of this polyp was consistent with a malignant melanoma infiltrating into a tubular adenoma. Subsequently, one of the subcutaneous lesions was biopsied and this revealed malignant melanoma cells metastatic in soft tissue. The primary site of the malignant melanoma could not be identified. CONCLUSION: Polyp-cancer sequence is well documented in colorectal cancer. The vast majority of malignant lesions found in adenomatous polyps in the colon are the consequences of malignant transformation from benign neoplastic colonic adenomatous tissue. The possibility that colonic adenomatous polyps could harbor metastatic tumors should also be entertained. This could change the treatment and may require an appropriate workup.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Colocolic intussusception in a three-year-old child caused by a colonic polyp.Colocolic intussusception is an uncommon cause of pediatric intestinal obstruction in north america; 95% of cases are ileocolic in location, with an equal percentage in which no pathologic lead point is evident on barium enema or laparotomy. In the last 20 years less than 3% of approximately 32,500 reported cases of intussusception originated in the colon. In a significant number of these cases juvenile polyps were identified as leading points. The majority of juvenile polyps occur in the rectosigmoid colon within the reach of a standard pediatric sigmoidoscope. These tumors most often cause painless hematochezia. Occasionally, juvenile polyps may grow large and serve as lead points for colocolic intussusception when located in the proximal colon. Pediatric patients presenting with documented colocolic intussusception should suggest the possibility of a colonic polyp or other mass lesion. Careful physical examination and barium studies should provide important diagnostic clues. Treatment is aimed at removing the lead point in patients presenting with intestinal obstruction. Colonoscopic polypectomy performed by an experienced endoscopist may serve as an alternative to surgical removal of the polyp. We report a case in a three-old-child of colocolic intussusception caused by a colonic polyp, and review some of the salient features of this clinical entity.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/5. Genetic predictability and minimal cancer clues in lynch syndrome ii.Increasing attention has been given to hereditary nonpolyposis colorectal cancer (HNPCC), a disorder which occurs four or five times more frequently than its hereditary counterpart, familial multiple adenomatous polyposis coli (FPC). Because of the lack of premonitory physical signs in HNPCC, its diagnosis must encompass pertinent family cancer history. This report describes a kindred with a subtype of HNPCC, the cancer family syndrome also referred to as lynch syndrome ii. Emphasis has been given to the temporal evolution of this disorder and the manner in which minimal clinical-genetic clues might best be employed for its diagnosis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/5. Colonic hamartomatous polyposis associated with hypertrophic osteoarthropathy.A 7-year-old girl with an unremarkable family history was admitted with complaints of diarrhea containing mucus and blood, abdominal pain, weight loss and fever for 10 months. Although her symptoms, physical examination and laboratory results were highly suggestive of inflammatory bowel disease, radiologic studies and colonoscopy demonstrated multiple colonic polyps. A bilateral and symmetric lamellar periosteal reaction and osteopenia were present on her extremity radiographs. The chest radiograph and thoracic CT scan were normal. The histologic nature of the polyps was determined as hamartoma. One month after subtotal colectomy, the patient's symptoms resolved and she gained 7 kg in weight. The association of generalized juvenile polyposis and hypertrophic osteoarthropathy has previously been described in five cases; arteriovenous malformations were present in four of them. In our case the polyps were hamartomatous and localized in the colon, without associated arteriovenous malformation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/5. Metastatic malignant mesothelioma presenting as colonic polyps.A 66-year-old male engineer diagnosed with malignant pleural mesothelioma 4 years previously had thoracotomy, radiotherapy, and chemotherapy. He was followed regularly with chest computed tomography (CT) scan and had been asymptomatic. During one of his physical examinations, routine sigmoidoscopy showed incidental colonic polyps which were biopsied. Subsequently, recurrence of pleural mesothelioma and peritoneal involvement by mesothelioma was documented. Two of the polyps showed metastatic malignant mesothelioma in the lamina propia which strongly resembled adenocarcinoma histologically causing difficulty in making definitive diagnosis. review of the literature disclosed no previously documented similar occurrence. This case shows the importance of clinical history and ancillary laboratory procedures such as immunohistochemistry and electron microscopy to avoid diagnostic pitfalls.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |