Case Presentation: Mucinous Adenocarcinoma of Cecum

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Case PresentationMucinous Adenocarcinoma of
Cecum

• Susanna L. Matsen
• Sinai Hospital
• April 20, 2006

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Case Presentation

• 70F presented 3/24/06 with increasing abdominal
  pain, distension and weight loss for several
  months acutely hematemesis, hematuria, no bowel
  movement x 5 days
• PMH IDDM, hypercholesterolemia, osteoarthritis
• Physical exam icteric sclera, jaundice,
  abdominal distension with voluntary guarding,
  tender RLQ with large palpable abdominal mass

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Case Presentation

• Labs total bilirubin 7.8 (direct 5.6), alkaline
  phosphatase 868, WBC 14.3, CEA and CA 19-9 in 60s
• CT scan omental caking, calcified mass in L
  adnexa, cholelithiasis, obstruction secondary to
  8.5 x 11 cm pelvic mass no liver or lung mets

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Case Presentation

• Pre-op ERCP with sphincterotomy and clearage of
  CBD stones ( CBD and common hepatic duct
  moderately dilated)
• CT-guided biopsy mucinous adenocarcinoma-
  ovarian vs. GI
• Plan operative debulking to improve quality of
  life
• 4/5/06 underwent subtotal abdominal colectomy,
  Hartmanns pouch, end-ileostomy, total abdominal
  hysterectomy, B oophorectomy, cholecystectomy

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Case Presentation

• Intraoperative findings
• Extensive omental caking
• 12 x 8 x 3 cm mass leading to bowel obstruction
• Tumor along L hemidiaphragm
• Pathology T3M2N1 mucinous adenocarcinoma with
  cecal primary
• lymphatic and vascular invasion, 5/8 lymph
  nodes, B ovaries, uterus, transverse colon,
  sigmoid and gallbladder with metastatic disease

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Mucinous AdenocarcinomaEtiology
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Kang et al 16,991 patients with Mucinous
Adenocarcinoma, 10 years of SEER National Cancer
Registry

• Accounts for 10-15 of all colorectal
  adenocarcinomas
• 147,000 new colorectal CA in U.S. in 2004
• A subtype in which gt 50 tumor composed of mucin
• Most commonly located in R colon (49.9)

Kang H et al. Dis Colon Rectum 2005481161-8.
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Mucinous AdenocarcinomaPathology
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Kang et al Results

• Mucinous slightly more common in women (53.4)
• 5.5 per 100,000
• Survival rate similar to adenocarcinoma when
  controlling for all variables

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Kang et al Results
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Kang et al Results
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Russo A et al 3,583 colorectal cancer patients
from 25 research groups in 17 countries
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Russo A et al., J Clin Onc 200523(30)7518-28.