IPLab:Lab 7:Metastatic Adenocarcinoma
This 58-year-old male was admitted five weeks earlier with a weight loss of 80 pounds over a six-month period, abdominal cramps, and rebound tenderness in the right lower quadrant. Abdominal and chest x-rays showed multiple nodularNodular hyperplasia of the prostate--characterized by large discrete prostatic nodules--is a common disorder in men over 50 years of age. The nodules cause the prostate to be enlarged and to have an increased weight. The human prostate is surrounded by a restrictive capsule. These nodules cause increased pressure within the capsule which leads to constriction of the urethra as it passes through the prostate. Urethral constriction leads to retention of urine. radiopacities in the lungs and liver. Fine needle biopsy of the liver revealed adenocarcinoma with the primary source thought to be colon. He was discharged on chemotherapy, but returned two days later with small bowel obstruction and sepsis, and he died a few days later.
Autopsy revealed an obstructive firm mass in the cecum with similar masses in the lungs, lymph nodes, liver and peritoneum. A large retrocecal abscessAn abscess is a collection of pus (white blood cells) within a cavity formed by disintegrated tissue. was found. Blood cultures grew Klebsiella pneumoniae and E. coli.
All colorectal tumors spread by direct extension into adjacent structures and by metastasis through the lymphatics and blood vessels. In order of preference, the favored sites of metastatic spread are the regional lymph nodes, liver, lungs, and bones, followed by many other sites, including the serosal membrane of the peritoneal cavity, brain, and others. Generally the disease has spread beyond the range of curative surgery in 25 to 30% of patients.
The lesions are spread throughout both the liver and the lung and they are variably-sized. There does not appear to be a large primary tumor with multiple small "daughter tumors." Of course these only suggest metastasis. To be sure of the source of the tumor immunohistologic stains for specific diagnostic markers would be performed on the tissues to determine the tissue of origin.
- eMedicine Medical Library: Imaging in Adenocarcinoma of the Colon
- eMedicine Medical Library: Colon Adenocarcinoma
- Merck Manual: Colorectal Cancer
- Merck Manual: Metastatic Liver Cancer
- Castro CY, Moran CA, Flieder DG, Suster S. Primary signet ring cell adenocarcinomas of the lung: a clinicopathological study of 15 cases. Histopathology 2001 Oct;39(4):397-401.
- PEIR Digital Library: Adenocarcinoma Images
- PEIR Digital Library: Metastatic Adenocarcinoma Images
- WebPath: Hepatic Neoplasms
- WebPath: Lung Neoplasms
Related IPLab Cases
- Lab 7: Colon: Adenocarcinoma
- Lab 7: Lip: Squamous Cell Carcinoma
- Lab 7: Esophagus: Squamous Cell Carcinoma
- Lab 7: Breast: Infiltrating Ductal Carcinoma
- Lab 7: Lung: Bronchogenic Carcinoma