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Tuesday, January 29, 2013

Video Showing Recurrent Mucinous Adeno Carcinoma Colon


Video showing DIAGNOSTIC LAPAROSCOPY in a young female patient with recurrent mucinous adeno carcinoma colon.

It shows the liver, peritoneum to be normal except for some adhesions

A ball of mucinous tumour close to the right adnexa but could be separated with ease from the right ovary and tubes





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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