The ABC of Health and Longevity in Olga Kopylova's program. The guest is Olga Nikolaevna Tkacheva, Chief Geriatrist of the Ministry of Health of the Russian Federation. Topic: "How to postpone old age?"
Clinical case - Colon cancer
Patient N., 54 years old.
Past diseases - measles in childhood.
Surgical interventions: 1995 - fibroma of the left breast.
Gynecological history - menopause 2 years, 1 pregnancy, 1 childbirth.
History of varicose veins n / a, osteochondrosis of the cervical spine.
Allergic history is not burdened.
Heredity - mother - stomach cancer, father - stroke.
I went to the gynecologist with complaints of discomfort in the lower abdomen, leucorrhoea, and also turned to the urologist with complaints of frequent urination with cuts.
Ultrasound of the pelvic organs: an echographic picture of the volumetric formation of the right ovary, myomas of the uterine body, signs of polyps of the cervical canal.
Complete blood count: Hemoglobin 129.10 g / L Erythrocytes 4.30 10 ^ 12 / L Hematocrit 36.41
General analysis of urine: erythrocytes unchanged 1,2.
- ECG, chest x-ray without pathology.
The outlet section of the stomach is clearly deformed due to a tumor-like formation up to 3-4 cm, examination is somewhat difficult due to the localization and deformation of the lumen, an ulcerative defect in the center of up to 10 mm with a fibrin-covered bottom is determined.
A biopsy was performed for histological examination, the mucous membrane during biopsy is rigid, cartilaginous, fragmented, bleeding markedly.
Conclusion: Tumor-like formation of the antrum of the stomach with the transition to the pylorus with deformation and slight narrowing of the lumen, biopsy
In the area of the transverse colon, a large stenosing circular formation of up to 5 cm is determined, narrowing the intestinal lumen to 1 cm, it bleeds markedly, it is difficult to pass the apparatus, biopsy for histological examination (using a guide string for better positioning of the apparatus).
On histological examination of the stomach formation: chronic superficial moderately pronounced inactive gastritis with foveolar periulcerous hyperplasia, adenoma with ulceration. There are no convincing signs of malignant growth in the volume of the studied material.
Histological examination from the formation of the large intestine: fragments of tubulo-villous adenoma with foci of severe dysplasia.
CA 19.9 884.7
PET / CT
The hypermetabolic process in the thickened walls of the colon and the surrounding tissue may correspond to the tumor process. Hypermetabolic formations in the peritoneum are most likely metastatic in nature.
In connection with the results of the histological examination, it was decided to repeat studies with a biopsy, performed after 3 days.
Histological examination of the formation of the stomach: Within the material delivered for the study, the morphological picture of moderate chronic gastritis with hyperplasia of the integumentary fossa epithelium, areas of significant edema, foci of fibrosis of the stroma of the lamina propria. No tumor growth was found within this material.
This result of histological examination was expected due to the fact that this tumor is an invasion of a tumor of the transverse colon, as can be seen from the images, and, most likely, at the time of examination, there is no invasion of the gastric mucosa.
Histological examination of the colon formation: in one of the presented fragments - fibrous tissue with adenocarcinoma complexes.
This clinical case is interesting in that, despite the number of biopsy fragments (in total, more than 14 fragments were taken in two studies), targeted biopsy from the foci of the most altered unstructured mucosa with areas of depression and impaired vascular pattern, as well as the use of biopsy forceps with volumetric jaws for multiple biopsy with a storage device, there are difficulties in the diagnosis of lesions due to mosaic histological structure of the tumor, even large lesions of the gastrointestinal tract, sometimes requiring repeated endoscopic examinations.
Colon cancer is one of the most common malignant neoplasms. According to the statistics of the last decade, the morbidity and mortality rates of patients with RTK are steadily growing in Russia and economically developed countries. Thus, from 2003 to 2013, the increase in malignant neoplasms of the colon was 23.43%, of the rectum, rectosigmoid section, and the anus - 17.90%.
The frequency of metastatic ovarian tumors (Krukenberg metastasis), according to various authors, ranges from 4.18 to 63% of all malignant tumors of this organ. Most often, tumors of the female reproductive system, breast and tumors of the gastrointestinal tract metastasize to the ovaries.
Metastases in the ovaries with colon tumors are, according to various authors, from 1.7 to 12% of cases. The incidence of multiple primary malignant neoplasms (PMN) of the ovaries and colon ranges from 0.8 to 12.6%.
The clinical picture of RTK with metastases to the ovaries is not very pronounced. With a common process, there is a violation of the function of the ovaries, pain in the lower abdomen and an increase in its volume, disorders of the function of adjacent organs (violation of urination), general disorders. For early diagnosis of ovarian damage, the diagnostic algorithm should include the determination of the level of tumor markers CEA, CA 19-9, CA 125, ultrasound of the pelvic organs and the abdominal cavity.
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