Colorectal Cancer

During an evaluation to detect metastatic disease in a 75-year-oldwoman with recently diagnosed cecal cancer, a CT scan of the abdomenand pelvis revealed an incidental finding of a heavily calcifiedgallbladder. No metastases were found. The patient had nosymptoms related to gallbladder disease.

A 70-year-old woman with no previousmedical problems had had progressivedyspnea and generalized weaknessfor the past several days. She washypotensive (73/31 mm Hg), tachycardic(120 beats per minute), andtachypneic (28 breaths per minute);oxygen saturation (room air) via pulseoximetry was 84%.

A 65-year-old woman, who was confined to a wheelchairbecause of severe rheumatoid arthritis, was concernedabout nodules that had erupted on her fingers and handsduring the previous 3 weeks (A). Her medical historyincluded colon cancer, chronic renal insufficiency, anemia,and hypertension. The nonpruritic nodules were painfulwhen they began to form under the skin; however, oncethey erupted, the pain disappeared.

Vague abdominal pain, malaise, anorexia,and the loss of 10 lb in 2months prompted a 65-year-old manto seek medical evaluation. A yearearlier he had undergone surgery forstage III carcinoma of the sigmoidcolon. Because metastases to thelymph nodes were found in the resectedcolon, the patient was given postoperativechemotherapy. Histologicexamination revealed poorly differentiatedadenocarcinoma.

An 85-year-old man was admitted to the hospital with acough and shortness of breath of 1 week’s duration anda fever and increased sputum production for 2 days. Hishistory included renal cell carcinoma and metastatic renalcancer for 2 years. The patient had smoked cigarettesfor 30 years. He had lost 30 lb during the last few months.A chest film revealed pneumonia of the right lowerlobe. Metastatic nodules were noted on the scalp; extensivelung, bone, and brain metastases also were found.

A 40-year-old man was concerned about an enlarging painlessmass on the right side of his neck that had been presentfor 6 months (A). The patient reported no other healthproblems; his medical history was unremarkable, and hewas taking no medications.There was no family or personal history of thyroiddisease or of exposure to radiation. Thyroid function testresults were within normal limits. A chest film revealed nopathology.

A 74-year-old woman was admitted to the hospital with abdominal pain, weight loss, fatigue, and change in bowel habits of 6 months’ duration. Her hemoglobin level was 7 g/dL; carcinoembryonic antigen, 672 ng/dL.

A 78-year-old man with a history of asthma, coronary artery disease, chronic obstructive pulmonary disease (COPD), and recently diagnosed prostate cancer was admitted to the medical ICU with exacerbation of COPD. The obtunded patient was unable to provide a history. A 4 × 6-cm firm nodule of unknown duration was noted over the right upper quadrant of the patient’s abdomen. There were no other cutaneous lesions.

An 85-year-old man presented with intermittent abdominal pain of several years’ duration. Two years earlier, he underwent a laparoscopic cholecystectomy that was converted to an open procedure.

During surgical resection for colon cancer, an 8.5-cm diverticulum was found incidentally in a 70-year-old man. The lesion arose from the antimesenteric surface of the terminal ileum; it was located about 2 ft proximal to the ileocecal junction. Palpation of the diverticulum revealed a hard mass at its tip and a thickened wall at its base.

An otherwise healthy 38-year-old woman presented to the emergency department with a 1-day history of generalized left-sided weakness. She had no other significant medical history and was taking no medications. The patient was overweight.

In a 65-year-old man with a family history of colorectal carcinoma, an initial screening coloscopic examination revealed 2 arteriovenous malformations. These delicate red lesions with a vascular network and irregular edges were found in the cecum.

A 62-year-old woman presented with a rash and intermittent pain of the right upper quadrant. The reticular, brown hyperpigmentation was also seen on her right flank and around the umbilicus. The patient reported that she often applied heating pads to these areas for pain relief.

A 65-year-old woman with metastatic adenocarcinoma of the colon was undergoing chemotherapy following a colectomy and a hepatic wedge resection. The physical examination and laboratory data were unremarkable.