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.


Related in: MedlinePlus

Biopsy-based diagnosis of signet-ring cell adenocarcinoma was confirmed by histology of the resected specimens. A, B: Microscopy (A: HE stain, × 40, B: HE stain, × 20) of surgical specimens demonstrating infiltration of the colonic wall by signet-ring cells; C, D: The tumor involves the cecum (C: HE stain, × 4) and the appendix (D: HE stain, × 4); E, F: Microscopy showing metastases to the ovary (D: HE stain, × 10) and lymph nodes (E: HE stain, × 10).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Biopsy-based diagnosis of signet-ring cell adenocarcinoma was confirmed by histology of the resected specimens. A, B: Microscopy (A: HE stain, × 40, B: HE stain, × 20) of surgical specimens demonstrating infiltration of the colonic wall by signet-ring cells; C, D: The tumor involves the cecum (C: HE stain, × 4) and the appendix (D: HE stain, × 4); E, F: Microscopy showing metastases to the ovary (D: HE stain, × 10) and lymph nodes (E: HE stain, × 10).

Mentions: The pre-operative patient work-up included computed tomographic imaging of the chest and upper abdominal region, which revealed no extraintestinal manifestations of amebiasis, and explorative laparoscopy (Figure 4A and B) along with cytological examination of and biopsies from the peritoneum, which showed peritoneal carcinomatosis. After treatment with metronidazole, the patient underwent chemotherapy. Four months after diagnosis, right-sided hemicolectomy, omentectomy and Douglas-resection with hysterectomy and bilateral salpingo-oophorectomy were performed. Gross pathology of the surgical specimens showed tumor involvement of the cecum, the appendix and the ileocecal valve (Figure 5A). Metastases were found in the regional lymph nodes, the ovaries (Figure 5B), the fallopian tubes, the peritoneum, the omentum and the diaphragm. The biopsy-based diagnosis of signet-ring cell adenocarcinoma was confirmed by histology of the resected specimens (Figure 6A-F).


Diagnosis of colonic amebiasis and coexisting signet-ring cell carcinoma in intestinal biopsy
Biopsy-based diagnosis of signet-ring cell adenocarcinoma was confirmed by histology of the resected specimens. A, B: Microscopy (A: HE stain, × 40, B: HE stain, × 20) of surgical specimens demonstrating infiltration of the colonic wall by signet-ring cells; C, D: The tumor involves the cecum (C: HE stain, × 4) and the appendix (D: HE stain, × 4); E, F: Microscopy showing metastases to the ovary (D: HE stain, × 10) and lymph nodes (E: HE stain, × 10).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Biopsy-based diagnosis of signet-ring cell adenocarcinoma was confirmed by histology of the resected specimens. A, B: Microscopy (A: HE stain, × 40, B: HE stain, × 20) of surgical specimens demonstrating infiltration of the colonic wall by signet-ring cells; C, D: The tumor involves the cecum (C: HE stain, × 4) and the appendix (D: HE stain, × 4); E, F: Microscopy showing metastases to the ovary (D: HE stain, × 10) and lymph nodes (E: HE stain, × 10).
Mentions: The pre-operative patient work-up included computed tomographic imaging of the chest and upper abdominal region, which revealed no extraintestinal manifestations of amebiasis, and explorative laparoscopy (Figure 4A and B) along with cytological examination of and biopsies from the peritoneum, which showed peritoneal carcinomatosis. After treatment with metronidazole, the patient underwent chemotherapy. Four months after diagnosis, right-sided hemicolectomy, omentectomy and Douglas-resection with hysterectomy and bilateral salpingo-oophorectomy were performed. Gross pathology of the surgical specimens showed tumor involvement of the cecum, the appendix and the ileocecal valve (Figure 5A). Metastases were found in the regional lymph nodes, the ovaries (Figure 5B), the fallopian tubes, the peritoneum, the omentum and the diaphragm. The biopsy-based diagnosis of signet-ring cell adenocarcinoma was confirmed by histology of the resected specimens (Figure 6A-F).

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.


Related in: MedlinePlus