Right Flank Pain Caused by a Sigmoid Colon Mass

Our plain-English summary of Right Flank Pain Caused by a Sigmoid Colon Mass, by A. Su, M. Farid (Gastroenterology, 2019).

The study

• Authors: A. Su, M. Farid
• Journal: Gastroenterology
• Published: 2019;157(2):e12-e13
• Type of article: Case report
• Read it: PubMed · Publisher

In plain English

This article was a clinical image case report about one patient. A 53-year-old man with no significant past medical history went to an emergency room with 3 months of right-sided flank pain. He had worked briefly in construction before working in restaurants. A CT scan showed a large, 8.5-cm mass arising from the sigmoid colon, along with widespread enlarged lymph nodes and multiple liver lesions. Colon cancer was first suspected, but sigmoidoscopy found no obvious discrete mass, only a subtle protrusion, which was biopsied. Tissue staining was consistent with malignant mesothelioma, epithelioid type. Later liver biopsies and 2 pleural biopsies did not give a diagnosis. The diagnosis was confirmed again a year later, after his disease progressed and a large epidural tumor was removed by palliative surgery. The authors noted that mesothelioma is associated with asbestos exposure, but said it was unclear whether he had been exposed during his construction job. They described the case as an unusual presentation of metastatic peritoneal mesothelioma invading the sigmoid colon. They concluded that tumor invading the bowel from outside should be considered when irregular, protruding lining is seen during endoscopy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (clinical challenge and image article) of a single patient
• Who was studied: one 53-year-old man who presented to an emergency room with 3 months of right-sided flank pain; he had moved to the United States from Turkey more than 20 years earlier; the authors are from the David Geffen School of Medicine at UCLA, Los Angeles
• Exposure: the patient had worked briefly in construction before working in restaurants; the authors stated it was unclear whether he had been exposed to asbestos during that construction job; no fiber type or dose was reported
• Main results:
  • CT scan of the abdomen and pelvis showed a large, 8.5-cm, fungating mass arising from the sigmoid colon, with diffuse retroperitoneal and periaortic lymphadenopathy and multiple hepatic lesions
  • on sigmoidoscopy no obvious discrete mass was seen on insertion; on withdrawal, at 30 cm from the anal canal, there was only a subtle friable protrusion, which was biopsied
  • histology showed tumor infiltrating the lamina propria of the colonic mucosa, without associated dysplasia of the colonic epithelium
  • immunohistochemistry was positive for keratin 7, calretinin, D2-40 and WT-1 and negative for keratin 20, CDX2 and TTF-1; the findings were consistent with malignant mesothelioma, epithelioid type
  • subsequent liver biopsies and 2 pleural biopsies were nondiagnostic
  • the diagnosis was confirmed again a year later, after disease progression and palliative resection of a large infiltrating epidural tumor
  • laboratory tests showed only a mild normocytic anemia, with hemoglobin of 12.5 g/dL (reference range 13.5 to 17.1 g/dL)
• The authors' conclusion: The authors concluded that the case was a unique presentation of metastatic peritoneal mesothelioma with a primary discrete lesion arising from and invading the sigmoid colon, and that external tumor invasion should always be considered when protruding irregular mucosa is seen during endoscopy
• Limitations the authors state:
  • the authors stated it was unclear whether the patient had been exposed to asbestos

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

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