Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2021; 9(26): 7901-7908
Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7901
Delayed diagnosis of ascending colon mucinous adenocarcinoma with local abscess as primary manifestation: Report of three cases
Shang-Zhi Han, Rong Wang, Kun-Ming Wen
Shang-Zhi Han, Rong Wang, Kun-Ming Wen, Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Wen KM put forward the idea of the article; Han SZ and Wen KM were both the patients’ doctors in charge and performed surgical treatment; Han SZ collected the case data and completed the writing of the article; Wang R and Wen KM revised the article.
Supported by the Science and Technology Fund Foundation of Guizhou, No. [2017]5733-053; and the Science and Technology Fund Foundation of Zunyi City, No. [2019]69.
Informed consent statement: All patients provided informed written consent before therapy.
Conflict-of-interest statement: All authors declare that they have no financial relationships to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kun-Ming Wen, MD, Chief Doctor, Professor, Surgeon, Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi 563000, Guizhou Province, China. doctober2020@163.com
Received: April 10, 2021
Peer-review started: April 10, 2021
First decision: May 11, 2021
Revised: May 24, 2021
Accepted: July 22, 2021
Article in press: July 22, 2021
Published online: September 16, 2021
Abstract
BACKGROUND

Colorectal mucinous adenocarcinoma is a distinct subtype of colorectal adenocarcinoma that is not sensitive to chemotherapy and radiotherapy, and its prognosis is worse than that of nonmucinous adenocarcinoma. Early diagnosis and aggressive surgical treatment may be the key to improving the prognosis of patients. Ascending colon mucinous adenocarcinoma with the primary manifestation of a local abscess caused by non-intestinal perforation has never been reported. Moreover, since the lumen of the ascending colon is large, and early stage ascending colon cancer lacks typical clinical manifestations, the diagnosis may be delayed easily. We herein report three cases of delayed diagnosis of colorectal mucinous adenocarcinoma.

CASE SUMMARY

We present three patients (two females and one male) with mucinous ascending colon mucinous adenocarcinoma with the primary manifestation of a local abscess (the right area of the lumbar spine, right groin, and lower right abdomen) caused by non-intestinal perforation. At the initial clinical visit, the common causes of those abscesses, including spinal tuberculosis and urinary tract infection, were excluded. The treatment of the abscess was through an incision and drainage. However, the source of the abscess was not made clear, which led to an abscess recurrence and a delayed diagnosis of colorectal mucinous adenocarcinoma. After the patients were referred to our hospital, a definitive diagnosis of ascending colon mucinous adenocarcinoma was made with the help of tumor markers and colonoscopic findings. Because of the delayed diagnosis of the disease, two patients (case 1 and case 2) missed the chance of surgery due to disease progression and died in a short follow-up period. Only case 3 underwent radical surgery for the tumor in the right colon and partial abdominal wall resection and achieved a better prognosis.

CONCLUSION

Abscesses in the right area of the lumbar spine, right groin, or right lower quadrant caused by non-intestinal perforation as the primary clinical manifestation of ascending colon mucinous adenocarcinoma are extremely rare. Mucinous adenocarcinoma of the ascending colon may be one of the causes of such abscesses. Performing colonoscopy as soon as possible is of great significance in the diagnosis and treatment of the disease.

Keywords: Delayed diagnosis, Colorectal mucinous adenocarcinoma, Local abscess, Case report

Core Tip: This paper presents three cases of delayed diagnosis of mucinous adenocarcinoma in the ascending colon with local abscess (caused by non-intestinal perforation) as the primary manifestation and emphasizes the importance of colonoscopy in the early diagnosis and surgical treatment of this malignancy.