SEER Training Modules
Case #1
History
67-year-old female with a history of diabetes and hypertension presenting to the emergency room with two weeks of constipation and increasing abdominal pain. No vomiting, no BRBPR, + flatus.
Physical Exam
Normal with no adenopathy or organomegaly.
Imaging
1/27/04
CT of the chest, abdomen and pelvis: Mediastinum demonstrates no definite mediastinal or hilar lymphadenopathy. There is no axillary lymphadenopathy seen. Liver demonstrates low attenuation, consistent with fatty infiltration. There is heterogeneous enhancement to the liver, especially to the left hepatic lobe. Given these findings, the possibility of a focal lesion cannot be excluded. MRI can be obtained if clinically indicated. Ascites is identified. Retroperitoneum demonstrates no evidence of lymphadenopathy.
Laboratory
- Hematocrit 27.7 (37.0-47.0 normal ranges)
- Hemaglobin 9.2 (12.0-16.0 normal ranges)
- CEA 3.5 (pre-operative) within normal limits
Surgical Observations
1/29/04
Proctosigmoidoscopy, exploratory laparotomy, right hemicolectomy: Rigid proctosigmoidoscopy revealed no lesions to 16 cm but the scope was unable to pass the point. Colon was found to be severely distended, with the cecum massively distended. Cecum was ischemic. There was a circumferential obstructing sigmoid lesion; which was resected. Liver was negative for metastatic disease.
Pathological Report
1/29/04
Colon, sigmoid resection: Adenocarcinoma, moderately differentiated, 3.5 cm, invasive through the bowel wall into the pericolonic fat. Vascular invasion is present. Six of seven (6/7) pericolic lymph nodes are positive for metastatic carcinoma. Margins are free of tumor.
