Images in Clinical Medicine
The Virtual Apple Core of a Colonic Carcinoma
N Engl J Med 2005; 352:2733June 30, 2005
- Article
A 67-year-old woman presented with a three-month history of abdominal pain, weight loss, and rectal bleeding. She had never been screened for colon cancer. Laboratory evaluation revealed a hematocrit of 32 percent and normal liver function. The patient was referred for computed tomography (CT) of the abdomen with integrated CT colonography. This technique combines contrast-enhanced CT scanning of the abdomen and pelvis with rectal air insufflation to distend the colon. A coronal multiplanar reformatted image (Panel A) shows a constricting lesion in the distal transverse colon (white arrow), which has overhanging edges that suggest a malignant lesion. A low-attenuation, peripherally enhancing lesion in the liver (black arrow) is consistent with a metastasis. Three-dimensional reconstruction of the colonic air cast — a virtual air-contrast enema (Panel B) — shows an apple-core–like constriction (arrow). Endoluminal three-dimensional CT colonoscopy shows the overhanging distal edge of a lesion compatible with carcinoma of the colon (Panel A of the Supplementary Appendix, available with the full text of this article at www.nejm.org). The appearance of this virtual image is highly similar to the endoluminal photograph (Panel B of the Supplementary Appendix). A biopsy specimen revealed adenocarcinoma. The patient underwent resection of the transverse colon and the single hepatic metastasis. The mesenteric lymph nodes were without tumor. The patient underwent adjuvant chemotherapy and was free of disease at one year.
Eric M. Rubin, M.D.
Crozer–Chester Medical Center, Upland, PA 19013Vassilios D. Raptopoulos, M.D.
Beth Israel Deaconess Medical Center, Boston, MA 02215- Citing Articles (1)
Citing Articles
1
Mario Noti, Daniel Sidler, Thomas Brunner. (2009) Extra-adrenal glucocorticoid synthesis in the intestinal epithelium: more than a drop in the ocean?. Seminars in Immunopathology 31:2, 237-248
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