Limits...
Diagnosis of colonic amebiasis and coexisting signet-ring cell carcinoma in intestinal biopsy

View Article: PubMed Central - PubMed

ABSTRACT

Amebiasis is uncommon in developed countries. Several case reports in the literature emphasize that both the presenting symptoms and the radiological findings of colonic amebiasis closely resemble more common conditions, such as idiopathic inflammatory bowel disease and gastro-intestinal malignancy. We describe a unique case of colonic amebiasis (amebomas) coexisting with signet-ring cell carcinoma of the ileocecal valve, the cecum and the appendix. Endoscopically, the ulcerated tumor was indistinguishable from the ulcerations and pseudotumors (amebomas) detected in the ascending colon. Histological examination of biopsy specimens revealed the pathognomonic features of protozoa with ingested erythrocytes in combination with signet-ring cell infiltration. The author concludes that amebiasis may not only mimic carcinoma but, rarely, may coexist with carcinoma in the same patient. Clinicians and pathologists should be aware of this possibility in order not to delay diagnosis and treatment of malignant disease.

No MeSH data available.


Magnetic resonance imaging showed mural thickening of the ileocecum and the appendix, which was interpreted as being inflammatory in nature. A-E: Magnetic resonance images (A: T2-weighted magnetization transfer contrast transversal; B: T2-weighted fat saturated transversal; C: T2-weighted half-Fourier acquired single-shot turbo spin-echo transversal; D: T1-weighted VIBE-Dixon postcontrast transversal, E: T1-weighted VIBE-Dixon postcontrast coronal) showing mural thickening (arrows in A-C) of the ileocecum and the appendix with contrast enhancement (arrow in D, asterix in E).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5037093&req=5

Figure 1: Magnetic resonance imaging showed mural thickening of the ileocecum and the appendix, which was interpreted as being inflammatory in nature. A-E: Magnetic resonance images (A: T2-weighted magnetization transfer contrast transversal; B: T2-weighted fat saturated transversal; C: T2-weighted half-Fourier acquired single-shot turbo spin-echo transversal; D: T1-weighted VIBE-Dixon postcontrast transversal, E: T1-weighted VIBE-Dixon postcontrast coronal) showing mural thickening (arrows in A-C) of the ileocecum and the appendix with contrast enhancement (arrow in D, asterix in E).

Mentions: Laboratory tests revealed normocytic anemia (hemoglobin 105 g/L, hematocrit 0.34 L/L, and erythrocytes 3.70 T/L), with low vitamin B-12 (130 ng/L), high serum iron (35.3 μmol/L), significantly increased serum ferritin (1042 μg/L) and normal transferrin, as well as neutrophilic leukocytosis (leukocytes 11.52 G/L and neutrophils 9.30 G/L). Magnetic resonance imaging (MRI) showed mural thickening of the ileocecum and the appendix, which was interpreted as being inflammatory in nature (Figure 1); there was no evidence of an abscess. MRI also disclosed a nonhomogeneous, cystic mass of the left ovary that measured 7.9 cm in diameter. Gastroscopy and proctoscopy including anorectal examination were inconspicuous. Colonoscopy revealed multiple ulcerations and up to 10 well-circumscribed, ulcerated, tumor-like masses, separated by normal mucosa, in the ascending colon (Figure 2A and B). The masses were livid-colored at the periphery and necrotic at the center, and these masses ranged in size from 8 mm to 33 mm in diameter. A similar, but larger (4.5 cm in diameter) and more solid lesion was found at the ileocecal valve involving the adjacent cecum and the appendix (Figure 2C and D). These endoscopic manifestations were considered to be inconclusive. While the ulcerated lesions were found to be atypical of Crohn’s disease, differential diagnoses included tuberculosis, lymphoma and carcinoma.


Diagnosis of colonic amebiasis and coexisting signet-ring cell carcinoma in intestinal biopsy
Magnetic resonance imaging showed mural thickening of the ileocecum and the appendix, which was interpreted as being inflammatory in nature. A-E: Magnetic resonance images (A: T2-weighted magnetization transfer contrast transversal; B: T2-weighted fat saturated transversal; C: T2-weighted half-Fourier acquired single-shot turbo spin-echo transversal; D: T1-weighted VIBE-Dixon postcontrast transversal, E: T1-weighted VIBE-Dixon postcontrast coronal) showing mural thickening (arrows in A-C) of the ileocecum and the appendix with contrast enhancement (arrow in D, asterix in E).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037093&req=5

Figure 1: Magnetic resonance imaging showed mural thickening of the ileocecum and the appendix, which was interpreted as being inflammatory in nature. A-E: Magnetic resonance images (A: T2-weighted magnetization transfer contrast transversal; B: T2-weighted fat saturated transversal; C: T2-weighted half-Fourier acquired single-shot turbo spin-echo transversal; D: T1-weighted VIBE-Dixon postcontrast transversal, E: T1-weighted VIBE-Dixon postcontrast coronal) showing mural thickening (arrows in A-C) of the ileocecum and the appendix with contrast enhancement (arrow in D, asterix in E).
Mentions: Laboratory tests revealed normocytic anemia (hemoglobin 105 g/L, hematocrit 0.34 L/L, and erythrocytes 3.70 T/L), with low vitamin B-12 (130 ng/L), high serum iron (35.3 μmol/L), significantly increased serum ferritin (1042 μg/L) and normal transferrin, as well as neutrophilic leukocytosis (leukocytes 11.52 G/L and neutrophils 9.30 G/L). Magnetic resonance imaging (MRI) showed mural thickening of the ileocecum and the appendix, which was interpreted as being inflammatory in nature (Figure 1); there was no evidence of an abscess. MRI also disclosed a nonhomogeneous, cystic mass of the left ovary that measured 7.9 cm in diameter. Gastroscopy and proctoscopy including anorectal examination were inconspicuous. Colonoscopy revealed multiple ulcerations and up to 10 well-circumscribed, ulcerated, tumor-like masses, separated by normal mucosa, in the ascending colon (Figure 2A and B). The masses were livid-colored at the periphery and necrotic at the center, and these masses ranged in size from 8 mm to 33 mm in diameter. A similar, but larger (4.5 cm in diameter) and more solid lesion was found at the ileocecal valve involving the adjacent cecum and the appendix (Figure 2C and D). These endoscopic manifestations were considered to be inconclusive. While the ulcerated lesions were found to be atypical of Crohn’s disease, differential diagnoses included tuberculosis, lymphoma and carcinoma.

View Article: PubMed Central - PubMed

ABSTRACT

Amebiasis is uncommon in developed countries. Several case reports in the literature emphasize that both the presenting symptoms and the radiological findings of colonic amebiasis closely resemble more common conditions, such as idiopathic inflammatory bowel disease and gastro-intestinal malignancy. We describe a unique case of colonic amebiasis (amebomas) coexisting with signet-ring cell carcinoma of the ileocecal valve, the cecum and the appendix. Endoscopically, the ulcerated tumor was indistinguishable from the ulcerations and pseudotumors (amebomas) detected in the ascending colon. Histological examination of biopsy specimens revealed the pathognomonic features of protozoa with ingested erythrocytes in combination with signet-ring cell infiltration. The author concludes that amebiasis may not only mimic carcinoma but, rarely, may coexist with carcinoma in the same patient. Clinicians and pathologists should be aware of this possibility in order not to delay diagnosis and treatment of malignant disease.

No MeSH data available.