A Case of Colonic Ischemia Mimicking Carcinoma

Karamouzis, Michalis V.; Badra, Filitsa A.; Papatsoris, Athanasios

doi:10.1385/ijgc:32:2-3:165

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…Significantly, the endoscopic features of ischaemic colitis can mimic those of colorectal carcinoma, with more extensive inflammatory masses/ulcerations appearing as neoplastic. There are multiple case reports in the literature of similar endoscopic presentations and subsequent endoscopic and histological outcomes [9,11,12]. This case is of particular interest because of a descending colonic mass lesion, which turned out not to be malignant.…”

Section: Discussionmentioning

confidence: 84%

A Case of Colonic Ischaemia Masquerading as a Colonic Mass

Merwe¹,

Fagan²,

Armstrong³

et al. 2020

SCR

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Intestinal ischaemia is an uncommon vascular syndrome resulting from an acute or chronic drop in blood supply to the bowel, with varied clinical presentations. Intestinal ischaemia can present similarly to other conditions, leaving the clinician with a diagnostic dilemma. In this case report, we present a 69-year-old male who presented with abdominal pain, distention, anorexia and per rectal bleeding. Endoscopy showed a left-sided mass-like, ulcerated lesion, endoscopically thought to be colonic carcinoma. Histology later revealed this mass to be intestinal ischaemia, with no features of invasive carcinoma. This was confirmed at an interval endoscopy, which showed a largely healed mucosa and nil evidence of a mass. Raising awareness of this disease and its ability to mimic other presentations, both clinically and endoscopically, is key to establishing an early diagnosis and intervention.

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Section: Discussionmentioning

confidence: 84%

A Case of Colonic Ischaemia Masquerading as a Colonic Mass

Merwe¹,

Fagan²,

Armstrong³

et al. 2020

SCR

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“…While the non-occlusive causes include septic shock, hemorrhage shock, heart failure, cardiac arrhythmias, hemodialysis and medications [ 4 ]. Approximately 20% of patients with ischemic colitis have a potentially obstructing lesion, such as colon cancer, diverticulitis or leiomyoma [ 5 ]. Furthermore, risk factors associated with the development of disorder are age, diabetes mellitus, dyslipidemia, heart failure, peripheral arterial disease and treatment with hypotensive drugs.…”

Section: Discussionmentioning

confidence: 99%

Rectal ischemia causes mass formation, masquerading as rectal cancer

Fousekis

Aggeli

Gkogkos

et al. 2018

Oxford Medical Case Reports

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Rectal ischemia rarely occurs because of the rich vascular supply of the rectum, while endoscopic presentation of ischemic colitis always is not distinct and can uncommonly mimic malignant neoplasm. We present a case of a rectal ischemia, which presented with haematochezia and proctoscopy revealed a large ulcerating mass, masquerading as rectal cancer and obstructed the lumen of rectum. However, histological examinations showed only features for ischemic colitis and no evidence for malignancy. The patient was treated conservatively and 10 days later, new endoscopy showed complete disappearance of ulcerated mass, and new biopsies confirmed the initial diagnosis. Awareness and early diagnosis of ‘mass forming’ entity of ischemic colitis is very essential in order to carry out appropriate treatment and avoid severe complications.

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“…In addition, 2 previously reported cases showed resolution of the mass lesions 19 days after initial presentation. [7][8][9] Brandt et al 7 have previously suggested, predominantly on the basis of imaging findings, that the mass-like appearance may be due to submucosal edema and hemorrhage in cases that present with a polypoid mass and that submucosal or mural fibrosis with inflammatory granulation tissue may result in a malignant-appearing stricture in some cases. It has also been suggested that the polypoid mass-like presentation may represent an acute onset disease, whereas the stricture-like lesions may be a result of chronic low-grade ischemia and subsequent fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6] Occasionally, the diagnosis may not be straightforward because of atypical clinical or pathologic manifestations, and, in rare instances, ischemic colitis has been reported in association with a mass lesion mimicking malignancy. [7][8][9] This represents a challenging scenario because of the well-recognized association between colonic ischemia and colorectal carcinoma. 7,[10][11][12] Approximately 20% of colonic ischemia is associated with a benign or malignant obstructing mass, but in such cases the area of ischemia is typically either proximal to or within the region occupied by the mass lesion (so-called "obstructing colitis").…”

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confidence: 99%

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“Mass-forming” Variant of Ischemic Colitis Is A Distinct Entity With Predilection for the Proximal Colon

Khor

Lauwers

Odze

et al. 2015

American Journal of Surgical Pathology

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We systematically evaluated the clinicopathologic features and outcome of a rare, unusual variant of ischemic colitis that presents as a mass lesion mimicking malignancy on imaging or colonoscopy. A retrospective search was performed for cases with a histologic diagnosis of ischemic colitis and a clinical impression of malignancy. Of the 23 patients initially identified, 4 were excluded because clinical and histologic review showed mucosal prolapse (n=1), discrete colon polyp (n=2), and a diverticular mass (n=1) without concern for malignancy. The mass-forming variant of ischemic colitis (n=19) was seen predominantly in elderly (mean age 71.8 y) women (63.2%) with a striking predilection for the right colon (13/19), particularly the cecum (n=6). Abdominal pain (52.6%) and hematochezia (26.3%) were the most common presenting symptoms. A computed tomography scan showed segmental thickening suspicious for malignancy in 6/8 patients. Colonoscopy revealed an exophytic (n=16) or stricturing (n=3) mass with a mean size of 4.67 cm. Mucosal biopsies showed features typical for ischemic colitis in all cases. A colectomy was performed in 4 cases. In 2, the mass-like appearance was due to marked submucosal and mural edema, whereas in the other 2 cases, with a malignant stricture-like lesion, marked submucosal fibrosis and cholesterol emboli were present. No malignancy was identified on follow-up in any patient (mean 39.9 mo). Follow-up colonoscopy was performed in 7 patients 1 to 32 weeks after initial presentation and showed resolution of the mass in all cases. Awareness of this rare variant of ischemic colitis will prevent unnecessary resections in these patients.

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A Case of Colonic Ischemia Mimicking Carcinoma

Cited by 7 publications

References 13 publications

A Case of Colonic Ischaemia Masquerading as a Colonic Mass

A Case of Colonic Ischaemia Masquerading as a Colonic Mass

Rectal ischemia causes mass formation, masquerading as rectal cancer

“Mass-forming” Variant of Ischemic Colitis Is A Distinct Entity With Predilection for the Proximal Colon

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