Ileocecal valve adenocarcinoma.

Clinical History

60-year-old man who presents obstructive symptoms.

Imaging Findings

60-year-old man presented vomits and abdominal pain. He had not expulsed neither gas nor faeces. He had never been operated. Plain X-ray was compatible with obstruction. A CT was performed in order to clarify the cause and level of obstruction. A Multi–Detector Row CT-lightspeed64, GE- was used. An exophitic, irregular, pseudopolypoid mass was observed at ileocecal valve. This mass presented a moderate enhancement after the administration of IV contrast and was accompanied by some nearby lymph nodes. In addition, the mass was causing an obstruction. It was interpreted as a malignant tumor.

Discussion

Adenocarcinomas of the cecum account for one-fourth of all colic adenocarcinomas, ileocecal-valve adenocarcinoma account for 2% of all ileocecalvalve tumors. They have the same general and multi–detector row CT features as all other colic adenocarcinomas, including marked asymmetric colic wall thickening, short segment involvement, and abrupt change from normal to abnormal segments of colon. However, cecal adenocarcinomas have a tendency to be large, polypoid, and bulky and may act as the lead point for an intussusception. Although they may occupy a large proportion of the colic lumen, they rarely cause obstruction and often grow without clinical manifestations for long periods of time. Cecal adenocarcinomas may demonstrate mild local infiltration, even without perforation. However, wall thickening is more severe relative to pericolic infiltration than in most acute inflammatory diseases, particularly diverticulitis. The distal ileum may be affected and abnormally thickened in up to 10% of patients with right colic cancer as a result of tumor extension or, less commonly, a nontumoral process (congestion and edema).

Differential Diagnosis List

Final Diagnosis

Ilececal valve adenocarcinoma.

URL:	https://www.eurorad.org/case/6636
DOI:	10.1594/EURORAD/CASE.6636
ISSN:	1563-4086