Occult colon cancer with sepsis as the primary manifestation identified by bone marrow puncture: A case report

Figure 1 Computed tomography. A: The chest computed tomography (CT) revealed mild inflammation in both lungs, obvious in the right lung; B: Abdominal CT examination revealed thickening of the local intestinal wall in the ascending colon (pointed by the arrow).

Figure 2 The platelet count is severely depressed, while the white blood cell count and hemoglobin levels improve after treatment. Hb: Hemoglobin; WBC: White blood cell; PLT: Platelet.

Figure 3 Bone marrow biopsy. A: The bone marrow smear stained with Wright’s stain showed a class of abnormal cells (arrow points × 10); B: Clumps of cohesive cells, uneven size, abundant cytoplasm, irregular margins, rough chromatin, visible with 1-3 faint nucleoli (× 100).

Figure 4 ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography showed abnormally high signals in the ascending colon and left radius. A: Abdomen computed tomography (CT) showed a soft tissue mass in the right ascending colon, about 3 × 4 cm; B: ¹⁸F-fluorodeoxyglucose positron emission tomography (PET) showed that the mass of the right ascending colon showed significantly high uptake of ¹⁸F-FDG, with SUV_Max = 8; C: PET/CT examination showed a mass in the right ascending colon with significantly high uptake of ¹⁸F-FDG; D: ¹⁸F- fluorodeoxyglucose PET showed high signals in the ascending colon and left radius.

Figure 5 Autopsy and pathological results of the patient showed colon adenocarcinoma.