Bizarre Location of colorectal Cancer

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Bizarre Location ofcolorectal Cancer
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2002.11.23
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Brief history
A 59-year-old man with non-specific medical
history except tinnitus and vertigo. He came to
our PET center for a health examination and a hot
spot of increased FDG uptake was noted at RUQ of
the abdomen. Under the impression of colon
cancer he received colonoscopy and lower GI
double contrast series for comparison.
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FDG-PET image on Nov/14/2001
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Lower GI double Contrast series on Nov/16/2001
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PET
Lower GI double contrast series
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The RUQ lesion was thought to be a ascending
colon tumor in the PET images. However,
colonoscopy performed next day revealed a sigmoid
colon cancer measured 2cm in size at 25cm level.
Our surgeon thought that there were 2 primary
colon cancer in different locations. Under this
confusing situation, LGI double contrast series
was performed and the result proved that there
was only one tumor located in redundant sigmoid
colon. Surgery was performed 3 days after LGI
series. The pathology report proved that this
tumor was adenocarcinoma of Dukes B2 without any
lymph node metastasis.
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Teaching point
We have to keep in mind that the precise location
of GI tract can vary in different individuals.
Rare situation does exist and our physicians must
judge these images very carefully. If there is
any different result between different
examinations, other examination should be
performed to do an accurate diagnosis.
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Reference

• Gupta NC, Falk PM, Frank AL. et al.
  Pre-operative staging of colorectal carcinoma
  using positron emission tomography. Nebr Med J
  19937830-35
• 2. Akhurst T, Larson SM. Positron emission
  tomography imaging of colorectal cancer. Semin
  Oncol 199926(5)577-583