![]() The appearance of the apple-core lesion of the colon can be caused by several diseases. Unfortunately, his condition deteriorated after developing a chest infection and died two weeks after the operation. All those findings confirmed an adenocarcinoma, Dukes’ B, pT4N0Mx. Thirteen lymph nodes were identified and none of them showed metastatic deposits. One other hyperplastic polyp was also identified. The rest of the polyps were moderately dysplastic tubulovillous and tubular adenomas. The largest polyp was a severely dysplastic tubulovillous adenoma. An area suspicious of extramural lymphovascular invasion was also seen. The tumour was present at the serosa (pT4). The tumour had an infiltrating growth pattern with minimal lymphocytic infiltration at the advancing edge. Microscopy showed moderately differentiated adenocarcinoma ( Figures 3, ,4). The terminal ileum was sliced through the wall at approximately 40 mm from the proximal end and was attached to the rest of the ileum by a strand of ileal tissue only. The background mucosa showed six polyps in total, measuring between 4 mm and 25 mm, and the largest lied 60 mm from the proximal resection margin. Other findings included full thickness (probably incisional) defect, 30 mm in maximum diameter that lied 80 mm proximal to the tumour and adjacent to a 24 mm sessile polyp ( Figure 2). The tumour was present at the serosal surface, and was situated 40 mm from the distal resection margin and 160 mm from the proximal resection margin. Macroscopic examination of the specimen revealed a 50 mm × 45 mm circumferential tumour in the large bowel, and invading the full thickness of the wall. He underwent a radical right hemicolectomy in November 2007. His Haemoglobin was 6.0 gm/L.Ībdominal CT ( Figure 1) showed an apple-core stenosing tumour in the proximal transverse colon and a 2 cm intra-luminal lesion in the mid-ascending colon. He had a history of a left pneumonectomy in 1985 for a squamous cell carcinoma of the lung, Chronic Obstructive Airway Disease, Benign Prostatic Hypertrophy and diverticulosis. He was anaemic on physical examination with no other clinical findings. The colon (C) is again seen to be dilated to the splenic flexure (yellow arrow).An 86-year-old white English man was referred to the surgical clinic in September 2007 for melaena and weight loss. On CT, there is gas in the bowel wall (white arrows). White arrow on conventional radiograph points to air in colon which abruptly terminates at the splenic flexure. Inflammatory Bowel Disease such as Crohn’s DiseaseĬolon Cutoff Sign. ![]()
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