TP1.2.2CT Colonography (CTC) Should be the ‘Gold Standard’ in Suspected Colonic Malignancy: Results of a Retrospective Cohort Study

Aim Colonoscopy is the ‘gold’ standard with CT Colonography (CTC) being an alternative to investigate symptoms of colorectal cancer (CRC). Colonoscopy is invasive and can be embarrassing and distressing for patients. This retrospective cohort study aimed to investigate the validity of CTC in patients with suspected CRC. Methods We retrospectively reviewed 815 electronic patient records for those undergoing CTC in a large teaching hospital, between 2013 and 2015. Demographic data in addition to specific data on indication for CTC, endoscopic evaluation and further radiological imaging was collected until 2018. Results Mean age of the cohort was 67 (21 - 93 years). 326 (40%) patients underwent lower GI endoscopy in the three months preceding CTC, whilst 90 (11%) patients underwent endoscopy in the year following CTC. 37 patients had a CT Colonography Reporting Data System score (C-RADS) of C4 suggesting a colonic malignancy. Of these 21 (57%) were confirmed CRC, others demonstrated benign pathology (32%) or were unit or lost to follow up (11%). 56 (7%) had C-RADS of E4 suggesting significant extracolonic findings, 6 (11%) of which were renal cell carcinomas. Only 2 patients went on to develop a colorectal malignancy within our follow up period. Conclusions This large retrospective cohort study demonstrates that CTC is a reliable and valid tool. The authors propose that CTC should be the first line investigation with endoscopy reserved for use as an adjunct for diagnosis.Despite the limitations of a retrospective review, we were able to generate large patient numbers in order to establish our outcomes.

Non-Steroidal Anti-Inflammatory Drugs: A Rare Cause of Colonic Mass

NSAIDs (non-steroidal anti-inflammatory drugs) are one of the most used medications worldwide. Every day they are used by more than 30 million Americans. Here, we report a rare and interesting case of a 63-year-old woman with a history of NSAID use who presented to our emergency room with lower abdominal pain. Computed tomography (CT) scan of the abdomen with intravenous contrast revealed focal mucosal thickening in the cecum which was highly suspicious for colonic malignancy. She had a colonoscopy which showed two masses and ulcers in the right colon, pathology was negative for malignancy and showed inflammation consistent with NSAID colopathy.

Giant lipoma of descending colon masquerading as a colonic malignancy

Lipomas of the large intestine are uncommon tumour. They are often innocuous and do not cause any clinical problem, particularly if they are small (<2 cm) is size. However, they can give rise to significant clinical symptoms if they become large and can be mistaken for colorectal carcinoma. Herein, a giant submucosal lipoma of descending colon is described, which was preoperatively suspected of carcinoma and underwent left hemicolectomy. The diagnosis was only reached after pathological examination of the resected tumour. The case highlights that a large colonic lipoma still poses diagnostic difficulty. Accurate diagnosis of the lipomas is important as they can be removed by endoscopic polypectomy or segmental resection, obviating the need of unnecessary major surgical resection.

Unusual complication of colonic carcinoma: colonopleurobronchial fistula

Colonopleurobronchial fistula (CPBF) is a rare complication which occurs due to diversified causes. Expectoration of the faecal material is the classical clinical symptom which suggests the diagnosis. Various causes include infection of pulmonary or abdominal origin, inflammatory bowel disease, colonic malignancy, diaphragmatic hernia and colonic interposition. Crohn’s disease is the frequent underlying pathology, colonic malignancy accounts for rare cause. Due to the presence of liver in right upper quadrant, most of the fistulas are on the left side. Here we describe a rare case of a 38-year-old man presented with right-sided CPBF due to underlying colonic malignancy. Bronchial block was done, however the patient succumbed to death.

Double Trouble: A Rare Association between Chronic Total Occlusion of the Left Main Coronary Artery and Colonic Malignancy

Emerging evidence has shown an association between cardiovascular (CV) disease and cancer due to shared risk factors and biological mechanisms especially chronic inflammation. The objective of this case report is to highlight the association between these two lethal diseases and the challenges in the management of coronary artery disease in patients with coexisting malignancy.A 65-year-old nonsmoker, nondiabetic, and normotensive male presented with a history of abdominal pain and significant weight loss. Colonoscopy and biopsy showed adenocarcinoma of the ascending colon, and he was planned for right hemicolectomy. Electrocardiogram exercise stress test performed as a part of preoperative evaluation was strongly positive. Coronary angiography was suggestive of Chronic total occlusion of the left main coronary artery. Though the syntax score was intermediate, coronary artery bypass grafting was decided as the revascularization strategy as he needed early surgery for the colonic malignancy. A month later, he underwent right hemicolectomy.Clinicians should be aware of the association between CV disease and cancer as they are likely to face similar situations where both coexist. Understanding the connections between heart disease and cancer will help to formulate combined preventive guidelines.

Synchronous colonic malignancy and tuberculosis: a rare histologic surprise

Coexistence of colorectal cancer and tuberculosis of same site is described in few of case reports. Tuberculosis (TB) is known to involve any part of the body. Intestinal TB accounts for the majority of extra pulmonary TB, ileocecal region being the most common site. TB has been known to be associated with various types of malignancy. The most common association is malignancy and pulmonary TB. However, association of extra pulmonary TB and malignancy at the same site is relatively uncommon. This case report describes synchronous colonic malignancy and tuberculosis on histopathological evaluation of the resected specimen in a 42-year female patient.