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|Year : 1982 | Volume
| Issue : 2 | Page : 107-8B
Synchronous double carcinoma of colon (a case report).
Mohanty BN, Vohra RR, Kohli PK, Malik AK, Suri SS
|How to cite this article:|
Mohanty B N, Vohra R R, Kohli P K, Malik A K, Suri S S. Synchronous double carcinoma of colon (a case report). J Postgrad Med 1982;28:107-8B
Carcinoma of the colon is relatively uncommon in Indians as compared to the western population. Multiple cancers of the colon are very rare. The present communication describes the only case of synchronous double carcinoma of the colon seen at PGI, Chandigarh over the last ten years.
J.K., a 50 year old female patient was admitted at the Institute hospital with a history of dull aching pain in the left side of abdomen for 3 months. She had lost about 5 kg of body weight and had a mild loss of appetite. There was no history of alteration of bowel habits nor any abdominal distension. There was no history suggestive of polyposis coli or ulcerative colitis in the patient previously nor in any of her family members. Abdominal examination revealed a mobile, firm, nontender lump with an irregular surface, in the left hypochondrium. Liver was not palpable and there was no ascites. Rectal examination revealed no abnormality.
Haemogram, urine and stool examination, liver function tests and X-ray of the chest were normal. Barium enema showed a shore narrow segment in the middle third of the descending colon with shouldering effect and another irregular filling defect in the left third of the transverse colon [Fig. 1]. Colonoscopy showed polypoid growths producing narrowing in these two regions with an intervening normal mucosa. Biopsy from both the lesions showed well differentiated adenocarcinoma. At laparotomy, the two lesions were confirmed. Moderately enlarged epicolic nodes were present in the transverse mesocolon. Rest of the colon was normal and so were the liver and other viscera. Resection including the left 2/3rd of the transverse colon, splenic flexure, descending colon and upper third of the sigmoid colon, and primary colo-colic anastomosis were performed. The resected specimen showed two narrow segments separated by a distance of 13 cm [Fig. 2]. On cutting open, there was an ulcerated circumferential growth 4 cm x 4 cm in the descending colon, 9 cm proximal to the distal resection line. A similar lesion in the transverse colon measured 3 cm x 3 cm. On microscopic examination, both the growths showed features of well differentiated adenocarcinoma [Fig. 3] with transmural spread upto the serosa with evidence of perineural lymphatic invasion in many foci. There was however, no vascular or lymph node invasion. Resection lines were free. Representative blocks of colon between these two lesions did not show any submucosal or lymphatic spread. The overlying mucosa was normal [Figure - 4]. Thus a diagnosis of adenocarcinoma arising independently at two sites in the colon was suggested.
The patient made an uneventful postoperative recovery. At 4 months' follow up, she is asymptomatic, has a normal bowel habit, and has gained 2 kg in weight.
Czerny was the first to report multiple carcinoma of colon in 1880. Moertel et al, in 1958, found the incidence to be 4.3% of all cancers of colon. They also observed a marked tendency to multiplicity of carcinoma in cases of polyposis coli and ulcerative colitis. Two thirds of their cases occurred synchronously and the remainder metachronously. Carcinoma of colon is relatively uncommon. in India as compared to the western population. Synchronous multiple cancers are still rarer. The present case is the only one that has been seen at the Institute hospital over the last 10 years. It fulfils all the pathological criteria laid down by Moertel et al. Copeland et all found that 59% of patients with synchronous carcinoma of colon had associated polyps while 9% of Moertel's patients had associated chronic ulcerative colitis.
Our patient had neither of the two. Individual multiple tumours tend to behave as do the single ones except that obstruction is extremely uncommon, and there is no significant difference in the long term survivals between the two categories.
We are indebted to Dr. S. P. Kaushik for permitting us to publish his case.
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