A Man With Colon Cancer and Tonsil Swelling
| Autor: | Pascale Cervera, Aimery de Gramont, Frédéric Lemay |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Oncology
medicine.medical_specialty Hepatology biology medicine.diagnostic_test business.industry Colorectal cancer Gastroenterology Physical examination medicine.disease medicine.anatomical_structure Carcinoembryonic antigen Tonsil Internal medicine Biopsy medicine biology.protein FOLFIRI Adenocarcinoma Stage IIIC Radiology business |
| Zdroj: | Gastroenterology. 142:1423-1625 |
| ISSN: | 0016-5085 |
| DOI: | 10.1053/j.gastro.2012.01.002 |
| Popis: | Question: A 43-year-old man was evaluated for left tonsil swelling. He had been diagnosed 1 year earlier with a left-sided colon cancer revealed by altered bowel habits. At diagnosis, the preoperative evaluation did not show distant metastasis. The patient underwent left hemicolectomy, which showed a 4-cm, moderately differentiated adenocarcinoma invading the omentum (T4a). Thirty regional lymph nodes were positive for tumor extension (N2b). There was no microsatellite instability, and no KRAS mutations were found. The tumor was classified as stage IIIc disease based on the American Joint Committee on Cancer classification. The patient then received an oxaliplatin-based adjuvant chemotherapy (modified FOLFOX6) for 6 months. Three months after the end of chemotherapy, 2 pulmonary metastases were diagnosed, 1 in each lung. A positron emission tomographycomputed tomography also showed suspicious mediastinal adenopathy. An irinotecan-based treatment (FOLFIRI) with the addition of bevacizumab was then started. Three months later, the size of the lesions diminished and the patient underwent 2 successful lung surgeries to remove the metastases and the adenopathy. In the following months, the patient noticed a painless swelling of his left tonsil. He did not report symptoms of pharyngitis or tonsillitis. Physical examination revealed an ulcerated mass on the upper part of his left tonsil (Figure A, black arrow). There were no palpable ervical lymph nodes. The rest of the physical examination was unremarkable. The carcinoembryonic antigen level was 3.8. The omplete blood count was within normal limits. A biopsy of the left tonsil was performed. What is the diagnosis? Look on page 1625 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information n submitting your favorite image to Clinical Challenges and Images in GI. |
| Databáze: | OpenAIRE |
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