Case Scenario: Colon

History

69 year old male presented to GP with altered bowel habits including episodes of diarrhoea and occasionally blood present in stools. GP investigations showed evidence of Iron Deficiency Anaemia and he was urgently referred for gastrointestinal opinion.
Out-patient sigmoidoscopy showed an ulcerating tumour in the lower rectum.

Histology

Biopsies were taken of the tumour and showed portions of colonic mucosa with some benign/normal mucosal areas. There is focal replacement of normal glands by highly atypical epithelial cells showing rudimentary gland formation and areas of necrosis and inflammation. Cells have a high nuclear to cytoplasm ratio, show marked nuclear pleomorphism and mitotic figures are frequent, some appear abnormal. There is minimal architectural organisation. These appearances are diagnostic of colorectal adenocarcinoma which in this case appears poorly differentiated.

Outcome

The patient subsequently underwent abdominal-peritoneal resection of the rectum, sigmoid colon and anal canal. The tumour infiltrated the bowel wall muscle but did not extend through the muscle wall. The lymph nodes identified in adjacent tissues were free of metastatic tumour.
These finding indicate that this tumour is of Duke's Stage B, indicating a prognosis of 70% at 5 years.

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Slides and diagnosis kindly provided by Prof. Ian Ellis and Source BioScience.