Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

UNUSUAL PRESENTATION OF INVASIVE ADENOCARCINOMA IN A PATIENT WITH CHRONIC COMORBIDITIES: A CASE REPORT Sydney Ball, OMS-III 1 , George Mitchell, D.O. 2 2. Edward Via College of Osteopathic Medicine – Carolinas, Spartanburg, SC Cleveland Clinic Indian River Hospital, Vero Beach, FL

Imaging

Discussion

Introduction

Colorectal cancer (CRC) is one of the most common cancers in males and females and the 2nd leading cause of cancer deaths. Adenocarcinoma of the cecum is a form of CRC that starts in the mucous producing cells which lubricate the colon and rectum. Risk factors include increased age, family history or genetics, smoking, IBD, diet high in red meat, metabolic dysfunction, CAD, and obesity.

• Obesity, smoking, and systemic inflammation from comorbidities (COPD, CAD, diabetes) likely increased her cancer risk. 3 • One year prior, the patient came in with similar symptoms and an abdominal CT revealed similar heterogenous changes in the cecum but no follow up. Preventive measures should have likely been implemented by a PCP to address this sooner. • Surgical resection is the primary treatment for CRC in its early stages; this patient underwent an extended right hemicolectomy. 4 • CEA will be used for surveillance and reassessed post-op for a decrease. • The case highlights an unusual presentation of cecal adenocarcinoma in an older adult with chronic comorbidities and risk factors. This patient had an acute presentation of early stage colon cancer, contrasting with the more typical scenarios of idiopathic findings, asymptomatic patient, or subtle signs such as weight loss or change in bowel habits. • Her presentation of severe anemia, emphasizes the critical diagnostic principle: anemia in a male at any age or postmenopausal female should prompt evaluation for GI malignancy until proven otherwise. This case emphasizes the importance of recognizing the less common manifestations of colon cancer to ensure timely diagnosis and management. CRC is a leading cause of cancer death worldwide, highlighting the need for early detection and treatment. Notable findings include a cecal mass diagnosed as adenocarcinoma, along with chronic conditions that may impact disease progression and management. Conclusion

Figure 1. CT showing worsening/enlarged irregular heterogeneously enhancing mass, thickening of the cecum, highly concerning for colonic malignancy, with interval slight worsening of right mesenteric and upper abdominal mild lymphadenopathy.

Case Description

A 68-year-old female presented to the ED with lower abdominal pain, nausea and vomiting for one day. PMH - COPD, HTN, diabetes, hyperlipidemia, anemia, arthritis, and obesity. Surgical history - stent placement for CAD Social history - smoking (80.6 pack years). Family history - negative. Review of systems - 7/10 abdominal pain, nausea, and no bowel movement on arrival. Objective : Vitals: WNL. SpO2 averaged 92%, likely due to COPD. Physical Exam : Positive RLQ tenderness Labs: Anemia (Hb 7.5), metabolic acidosis, hyperglycemia (158), leukocytosis (14.1), thrombocytosis (620), elevated CEA (611). Imaging: CT abdomen/pelvis with contrast revealed a heterogeneously enhancing cecal mass causing partial bowel obstruction, with lymphadenopathy, perihepatic free fluid, and dilated loops of small bowel. Colonoscopy: A cecal tumor was identified and biopsied, and histopathology confirmed invasive adenocarcinoma with mucinous features. Assessment and Plan: Patient presents with SBO-like symptoms and abdominal pain in the setting of cecal adenocarcinoma . The final diagnosis was invasive adenocarcinoma of the cecum with mucinous features, staged as pT3N0 (Stage IIA). A NG tube was placed for decompression, and the patient underwent a right hemicolectomy with ileocolic anastomosis. Postoperative pathology confirmed no lymph node metastasis. She was discharged on postoperative day 11 with scheduled follow-up.

Figure 2. Normal Cecum on CT 1

Figure 3. Malignant partial obstructing tumor on colonoscopy

Discussion • Cecal adenocarcinoma does not commonly present with obstruction-like symptoms due to increased luminal size and liquid consistency of fecal matter in the proximal colon. 2 • Early-stage CRC typically presents asymptomatically or with subtle symptoms such as gradual weight loss and anemia. 2 • The patient's chronic conditions may have played a role in severity and presentation. Her comorbid conditions may have masked symptoms initially and caused for unusual presentation on admission. • Symptomatic patients at the time of diagnosis have more advanced disease and a worse prognosis. 2 Unlike advanced CRC, this patient had no lymph node involvement or metastasis, contributing to a better prognosis.

References

2025 Research Recognition Day

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