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Kayano H, Ueda Y, Machida T, Hiraiwa S, Zakoji H, Tajiri T, Mukai M, Nomura E. Colon cancer arising from colonic diverticulum: A case report. World J Clin Cases 2019; 7:1643-1651. [PMID: 31367623 PMCID: PMC6658384 DOI: 10.12998/wjcc.v7.i13.1643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/28/2019] [Accepted: 05/01/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Colonic diverticulosis is a common disease, and the coexistence of colonic diverticulosis and colorectal cancer is often seen clinically. It is very rare that colon cancer arises from the mucosa of a colonic diverticulum. When colon cancer arises in a diverticulum and then tends to develop outside the wall, without developing within the lumen, the differential diagnosis from complicating lesions due to colonic diverticulitis is difficult.
CASE SUMMARY A 76-year-old man was admitted to a nearby clinic with a chief complaint of discomfort and urinary frequency. Since a vesicosigmoidal fistula was seen on abdominal computed tomography, he was referred to our hospital. Laparoscopic sigmoidectomy was performed because the various diagnostic findings were diagnosed as a vesicosigmoidal fistula with diverticulitis of the sigmoid colon. However, on histopathological examination, it was diagnosed as a vesicosigmoidal fistula due to colon cancer arising in the diverticulum. Laparoscopic partial resection of the bladder was performed because local recurrence was observed in the bladder wall one and a half years after surgery. It is currently one year after reoperation, but there has been no recurrence or metastasis.
CONCLUSION Colon cancer arising in a diverticulum of the colon should be considered when diverticulitis with complications is observed.
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Affiliation(s)
- Hajime Kayano
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Yusuhiko Ueda
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Takashi Machida
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Shinichiro Hiraiwa
- Departments of Pathology, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Hidenori Zakoji
- Departments of Urology, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Takuma Tajiri
- Departments of Pathology, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Masaya Mukai
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
| | - Eiji Nomura
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo, Hachioji 192-0032, Japan
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Malignant Polyp in a Colonic Diverticulum: a Rare Cause of Diverticular Hemorrhage. J Gastrointest Cancer 2016; 43 Suppl 1:S104-7. [PMID: 21952946 DOI: 10.1007/s12029-011-9327-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sigmoid colon cancer arising in a diverticulum of the colon with involvement of the urinary bladder: a case report and review of the literature. BMC Gastroenterol 2014; 14:90. [PMID: 24884743 PMCID: PMC4030041 DOI: 10.1186/1471-230x-14-90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 05/07/2014] [Indexed: 12/24/2022] Open
Abstract
Background Colon cancer can arise from the mucosa in a colonic diverticulum. Although colon diverticulum is a common disease, few cases have been previously reported on colon cancer associated with a diverticulum. We report a rare case of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder, which presented characteristic radiographic images. Case presentation A 73-year-old man was admitted to our hospital for macroscopic hematuria. Computed tomography and magnetic resonance imaging revealed a sigmoid colon tumor that protruded into the urinary bladder lumen. The radiographs showed a tumor with a characteristic dumbbell-shaped appearance. Colonoscopy showed a type 1 cancer and multiple diverticula in the sigmoid colon. A diagnosis of sigmoid colon cancer with involvement of the urinary bladder was made based on the pathological findings of the biopsied specimens. We performed sigmoidectomy and total resection of the urinary bladder with colostomy and urinary tract diversion. Histopathological findings showed the presence of a colovesical fistula due to extramurally growing colon cancer. Around the colon cancer, the normal colon mucosa was depressed sharply with lack of the muscular layer, suggesting that the colon cancer was arising from a colon diverticulum. Conclusion The present case is the first report of sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder. Due to an accurate preoperative radiological diagnosis, we were able to successfully perform a curative resection for sigmoid colon cancer arising in a diverticulum with involvement of the urinary bladder.
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Oh KH, Han KH, Kim EJ, Lee JH, Choi KU, Han MS, Ahn JH, Cheon GJ. Colon cancer after acute diverticulitis treatment. Ann Coloproctol 2013; 29:167-71. [PMID: 24032118 PMCID: PMC3767867 DOI: 10.3393/ac.2013.29.4.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 03/19/2013] [Indexed: 12/17/2022] Open
Abstract
Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. Recently, we experienced three cases of colon cancer after treating acute diverticulitis, based on which we suggest the importance of follow-up colonoscopy after acute diverticulitis.
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Affiliation(s)
- Kwang Hoon Oh
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Kwon JH, Han KH, Chang WS, Nam KH, Han MS, Ahn JH, Han SH, Cheon GJ. A case of a mucinous adenocarcinoma arising from a rectal diverticulum. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2012; 28:222-4. [PMID: 22993710 PMCID: PMC3440493 DOI: 10.3393/jksc.2012.28.4.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 06/10/2012] [Indexed: 11/05/2022]
Abstract
The occurrence of an adenocarcinoma arising from a rectal diverticulum that causes mechanical ileus is very rare. Recently, we diagnosed a case of a mucinous adenocarcinoma in a rectal diverticulum after an emergent abdominal perineal resection and permanent colostomy by laparotomy. Here, we present a case report and a review of the literature.
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Affiliation(s)
- Jang Hoon Kwon
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Xu J, Yang L, Guo Y, Zhao D, Wang L, Bai L. Perforation of sigmoid diverticulum following endoscopic polypectomy of an adenoma. BMJ Case Rep 2010; 2010:bcr07.2009.2077. [PMID: 22461856 DOI: 10.1136/bcr.07.2009.2077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Colonic polyps or carcinomas located within a colonic diverticulum are very rare phenomena. There are a few reports in the literature describing adenocarcinoma arising within colonic diverticulum. Endoscopic resection of the polyp poses a risk of perforation because of the lack of muscular coats in the diverticulum. Therefore, special care should be taken in the treatment of such patients.
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Affiliation(s)
- Jing Xu
- Southern Medical University, Department of Gastroenterology in Nanfang Hospital, Guangzhou, Guangdong Province, 510515, China
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Fu KI, Hamahata Y, Tsujinaka Y. Early colon cancer within a diverticulum treated by magnifying chromoendoscopy and laparoscopy. World J Gastroenterol 2010; 16:1545-7. [PMID: 20333800 PMCID: PMC2846265 DOI: 10.3748/wjg.v16.i12.1545] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum. Endoscopic mucosal resection (EMR) was carried out successfully and completely with the assistance of laparoscopy. A 71-year-old man was admitted to our hospital because of melena and anemia. Emergent colonoscopy showed diverticulosis in the right-sided colon. However, endoscopy could not exactly detect the bleeding site. A flat elevated polyp was found within a single diverticulum located in the descending colon and diagnosed as an intramucosal carcinoma, as magnifying chromoendoscopy revealed a type IV pit pattern. As his diverticular bleeding repeated, a right-sided hemicolectomy was decided for treatment, the polyp within the diverticulum was also completely removed by EMR with the assistance of laparoscopy. Although a colonic perforation was detected immediately after EMR, the perforation was closed with endoclips intraluminally and also repaired laparoscopically from the serosal side. Histologically, the resected lesion was an intramucosal well-differentiated adenocarcinoma and the surgical margin was free of tumor.
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Soran A, Harlak A, Wilson JW, Nesbitt L, Lembersky BC, Wienad HS, O'Connell MJ. Diverticular Disease in Patients with Colon Cancer: Subgroup Analysis of National Surgical Adjuvant Breast and Bowel Project Protocol C-06. Clin Colorectal Cancer 2006; 6:140-5. [PMID: 16945170 DOI: 10.3816/ccc.2006.n.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Similar epidemiologic characteristics suggest a common etiology for colon cancer (CC) and diverticular disease of the colon (DD). The relationship between the 2 diseases is still unclear, and the impact of DD in patients diagnosed with CC on disease-free survival (DFS) and overall survival (OS) is unknown. National Surgical Adjuvant Breast and Bowel Project (NASBP) protocol C-06 is a clinical trial comparing oral uracil/tegafur/leucovorin with 5-fluorouracil/leucovorin in patients with resected stage II/III carcinoma of the colon. PATIENTS AND METHODS The NASBP enrolled 1,608 patients who had undergone potentially curative resection for stage II/III colon cancer from 256 medical sites between February 14, 1997, and March 31, 1999. RESULTS Pathology reports from 1561 eligible patients retrospectively reviewed for the presence of DD revealed that 160 (10.2%) had this disease. The median ages of patients with CC and DD and without DD were 67 and 61 years, respectively (P < 0.05). The majority of patients were white, and Hispanic patients were better represented in the group with DD (P < 0.05). Colon cancer was located in the rectosigmoid in 46.88% of patients with DD and in 31.92% of patients without DD (P < 0.05). A baseline diagnosis of DD made no significant contribution to DFS or OS without adjustment for confoundin factors (P = 0.2 and P = 0.32, respectively) or adjusted for Dukes classification and age (P = 0.49 and P = 0.68, respectively). CONCLUSION The prevalence of DD in patients diagnosed and treated for CC was 10.2%. Patients with CC with and without DD differed from each other with respect to age, tumor location, and ethnicity. There was no negative impact of having DD on DFS and OS in patients treated for stage II/III CC.
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Affiliation(s)
- Atilla Soran
- The National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers, USA.
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Wakahara T, Tsukamoto T, Kitamura S, Watanabe A, Tsujimura T, Nakamura Y, Toyokawa A, Onishi N, Hamabe Y, Mukai H, Teramura K. Metastatic colon cancer from intrahepatic cholangiocarcinoma. ACTA ACUST UNITED AC 2006; 12:415-8. [PMID: 16258812 DOI: 10.1007/s00534-005-0991-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 04/30/2005] [Indexed: 11/30/2022]
Abstract
A 62-year-old man had been followed because of an elevated serum level of carcinoembryonic antigen without the detection of any cancer lesions. However, there was a sudden increase in the serum level of carcinoembryonic antigen, and abdominal imagings showed a hepatic tumor with peripheral intrahepatic bile duct dilatation, and a submucosal tumor at the sigmoid colon with intact mucosa. Histopathological findings showed that the hepatic tumor had perineural invasion, suggesting an intrahepatic cholangiocarcinoma, and that the colon tumor infiltrated the submucosa, while its mucosa was intact. Both tumors showed similar pathological features and were positive for cytokeratin 20 and 7. These findings suggested intrahepatic cholangiocarcinoma with metastatic sigmoid colon cancer.
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Affiliation(s)
- Tomoyuki Wakahara
- Department of Surgery, Yodogawa Christian Hospital, 2-9-26 Awaji, Higashi Yodogawa-ku, Osaka 533-0032, Japan
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Barr YR, Brazowski E, Leider-Trejo L. Villous adenoma in a perforated colonic diverticulum. Int J Colorectal Dis 2006; 21:282-4. [PMID: 15703888 DOI: 10.1007/s00384-004-0694-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2004] [Indexed: 02/04/2023]
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Fearnhead NS, Mortensen NJM. Clinical features and differential diagnosis of diverticular disease. Best Pract Res Clin Gastroenterol 2002; 16:577-93. [PMID: 12406452 DOI: 10.1053/bega.2002.0299] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Colonic diverticulosis occurs in the majority of Western populations with age, but only a small proportion of people experience symptoms. Diverticular disease usually presents with either haemorrhage or diverticulitis. A quarter of patients with diverticulitis will develop complications including perforation, fistulation, obstruction or stricture. This chapter deals with the natural history, risk factors, clinical features and differential diagnoses of symptomatic diverticular disease.
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Affiliation(s)
- Nicola S Fearnhead
- Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Abstract
Diverticular disease is common in the elderly Western population and its complications are frequent clinical presentations. Despite this, the pathogenesis of the condition remains relatively poorly understood. Several theories have been developed, the most acceptable suggesting elastosis of the taeniae coli as the primary event, causing shortening of the sigmoid colon, with relative mucosal excess and subsequent mucosal herniations. A Western-type diet is implicated in the increased uptake of proline from the gut, leading to elastosis of the sigmoid colon. For pathologists, in clinical practice, the disease is most commonly seen in sigmoid colonic resection specimens, usually performed for complications of the disease. It is now realised that mucosal biopsies of the luminal mucosa, in the sigmoid colon affected by diverticular disease, can produce perplexing pathological changes. In particular diverticular colitis can mimic both ulcerative colitis and Crohn's disease: care should be taken when diagnosing chronic inflammatory bowel disease on a background of diverticular disease. For pathologists, diverticular disease remains something of an enigma: although common, its pathogenesis remains ill-defined and its complications can provide diagnostic difficulties, which require precise clinical and radiological correlation.
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Affiliation(s)
- Linmarie Ludeman
- Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
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