Carcinoembryonic antigen elevation due to bowel sequestration with mucocele formation following colonic resection
Department of Pathology & Laboratory Medicine, Graduate Hospital, Drexel University College of Medicine, Philadelphia, Pa 19146, USA.Archives of pathology & laboratory medicine (Impact Factor: 2.84). 11/2003; 127(10):1376-9. DOI: 10.1043/1543-2165(2003)127<1376:CAEDTB>2.0.CO;2
Carcinoembryonic antigen (CEA) is recommended as a serologic marker to monitor colorectal carcinoma recurrence. Elevations of CEA due to causes other than carcinoma exist and may lead to a misdiagnosis of recurrent carcinoma. We report a case of bowel sequestration with mucocele formation at the site of previous colo-colic anastomosis causing a mild elevation in CEA. The patient exhibited increasing CEA levels 6 years after resection of a sigmoid colon carcinoma with end-to-end anastomosis. Subsequently, computed tomographic and positron emission tomographic scans documented the presence of a cystic mass showing increased uptake at the anastomotic site. At exploratory laparotomy a mass lesion with mucus-filled protrusions was resected. Pathologic examination documented the presence of sequestration of a segment of the bowel wall with a mucocele and no overlying defect at the mucosal anastomotic site by demonstrating the presence of all bowel layers. After resection of the lesion, the CEA level normalized.
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ABSTRACT: F-18 fluorodeoxyglucose (FDG) combined positron emission tomography (PET)/ computed tomography (CT) imaging is often used in the surveillance of recurrent colorectal cancers after curative resections. We report 2 patients where FDG combined PET/CT imaging produced false positive results due to chronic inflammation and suture granuloma. Case 1 is a patient with a curative anterior resection done 10 months ago. Serial surveillance carcinoembryonic antigen (CEA) showed a marginal elevation. A solitary "hot spot" on combined PET/CT imaging was seen at the level of the previously resected inferior mesenteric vein. Case 2 is a patient with a positive solitary lesion on combined PET/CT imaging 16 months after a curative right hemicolectomy for colorectal cancer. The serum CEA was within normal limits. Both patients had undergone exploratory laparotomy with complete resection of the solitary lesions. The histology of Case 1 was reported as a suture granuloma while the histology of Case 2 was reported as an inflammatory nodule related to the previous suture pedicle, both with no malignant tissues identified. False positives on combined PET/CT imaging may result from inflammatory granulomas months after surgery.Annals of the Academy of Medicine, Singapore 09/2005; 34(7):457-60. · 1.15 Impact Factor
- The American surgeon 01/2010; 76(1):107-8. · 0.82 Impact Factor
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ABSTRACT: We report an unusual case of a giant colonic mucocele following ileo-sigmoid bypass surgery in a patient with advanced adenocarcinoma of the splenic flexure. The formation of a giant colonic mucocele resulted from distal splenic flexure obstruction due to tumour relapse and proximal caecal obstruction due to peritoneal disease with subsequent accumulation of mucus in the closed loop.03/2011; 2011(3):1-4. DOI:10.1093/jscr/2011.3.9
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