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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Metastatic carcinoma to the colon may be mistaken for inflammatory colitis, particulary Crohn's disease, both clinically and roentgenologically. Characteristic changes include mucosal thickening, nodular masses, multiple and eccentric strictures, asymmetric involvement, pseudosacculations, and spiculations of contour. This report, based upon experience with 12 cases, establishes the distinctive roentgen features of metastatic disease to the colon from a variety of primary sites. It is shown that these changes are dependent upon pathways of spread, growth characteristics, and local tissue response. The clinical importance of making this differential diagnosis is two-fold. A patient with an occult or a known primary malignancy may present clinically with metastatic disease to the colon masquerading as inflammatory colitis. Recognition of the characteristic roentgenologic changes immediately either leads to a search for the primary neoplasm or establishes the diagnosis of widespread disease.
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PMID:Metastatic carcinoma simulating inflammatory colitis. 111 62

We describe five patients who were initially thought to have Crohn's disease and were treated accordingly. The original diagnosis was based upon clinical presentation, roentgenograms, and histological examination, but subsequent follow-up showed that diagnosis to be in error. The following diagnoses were established instead: tuberculosis, Actinomyces Israeli infection, reaction to gold therapy, metastatic cancer, and linitis plastica. We stress the importance of considering conditions that can mimic Crohn's disease.
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PMID:Diseases of the intestine mimicking Crohn's disease. 135 28

Results after 55 colectomies are reported in the period from 1962-1986. The surgical intervention was indicated by ulcerative colitis in 19, Crohn's disease in 18 and familial polyposis of the colon in 18 cases. 37 total colectomies, 12 subtotal colectomies with ileorectal anastomosis and 6 colectomies with a remaining terminal closed stump of the rectum were performed. During the period of observation postoperative lethality decreased from 37% to 6%. Death was most frequently caused by thromboemboli and peritonitis. In 44% of the patients ill with familial polyposis malignant degeneration could be observed. 3 died by generalized metastases. Metabolism of protein, lipid and electrolyte showed no essential disturbances after colectomy. Intestinal assimilation was nearly standard. More difficult is social reintegration.
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PMID:[Results and late sequelae of colectomy]. 166 79

Eighty-four computed tomographic (CT) scans from patients referred for bowel obstruction between January 2, 1988, and December 31, 1989, were retrospectively evaluated. A pair of radiologists without knowledge of patient histories determined the presence or absence of bowel obstruction. Sixty-four patients ultimately proved to have intestinal obstruction, and 20 did not. Diagnosis was established by means of surgery (n = 39), barium studies (n = 17), and clinical course (n = 28). Causes of obstruction included adhesions (n = 37), metastases (n = 6), primary tumor (n = 7), Crohn disease (n = 4), hernia (n = 3), hematoma (n = 2), colonic diverticulitis (n = 2), and other (n = 3). In addition, 83 CT examinations in patients with no history or indication of intestinal obstruction were simultaneously reviewed. The overall sensitivity was 94%, specificity was 96%, and accuracy was 95%. The cause of obstruction was correctly predicted in 47 of 64 cases (73%). Intestinal obstruction was not diagnosed in any of the 83 control patients. CT is most useful in patients with a history of abdominal malignancy and in patients who have not been operated on and who have signs of infection, bowel infarction, or a palpable abdominal mass.
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PMID:Bowel obstruction: evaluation with CT. 206 89

The records of 51 patients diagnosed with enterovesical fistulas at Virginia Mason Medical Center from 1974 to 1988 were reviewed. Diverticulitis (41%), Crohn's disease (17%), and colorectal cancer (16%) were the major causes. In 50 of 51 patients, the diagnosis was made on the basis of the clinical history and the urine culture. Radiologic and endoscopic studies failed to identify the fistula in 20%, though all were confirmed at operation or autopsy. In four of eight patients with fistulas secondary to colorectal cancer, malignancy was not diagnosed preoperatively. Operation was performed in 84% of the patients. One-stage resection of the bowel was performed in 66% of patients with the intent of removing the fistula. The complication rate was 8% with no deaths. All multi-stage procedures were performed for fistulas complicated by abscess or bowel obstruction. There were two postoperative deaths in patients with metastatic cancer undergoing palliative diversion. All eight patients treated by diverting colostomy had persistent fistulas and urinary sepsis. All eight patients treated with antibiotics but without operation were free of complications of the fistula until death from other causes. Enterovesical fistula is a clinical diagnosis. Preoperative studies should be used to delineate the bowel disease and search for malignancy rather than to see the fistula, which is clinically apparent. One-stage resection of the involved bowel is the procedure of choice in the absence of abscess or bowel obstruction. When resection is not feasible, medical management with antibiotics is preferable to colostomy.
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PMID:Management of enterovesical fistulas. 233 17

A distinctive Crohn's disease-like reaction (CLR) consisting of discrete lymphoid aggregates, some with germinal centers, and surrounding stellate fibrosis is commonly found around colorectal adenocarcinomas in the absence of clinical or pathologic evidence of prior Crohn's disease. Most lymphoid aggregates are located one or more millimeters beyond the advancing tumor fronts, mainly in muscularis propria and pericolic adipose tissue. The intensity of this reaction was graded as absent, mild, or intense for 100 consecutive colorectal carcinomas. These tumors also were evaluated for invasion beyond muscularis propria, lymphoid infiltrates at the tumor margin, and nodal metastases. The degree of CLR was correlated with survival. Results indicated that CLR is more likely to occur in transmurally invasive carcinomas than in those confined to the colonic wall, especially in the right side. An intense CLR is associated with an intense lymphoid infiltrate at the tumor edge, a lower incidence of nodal metastases, and a statistically significant increase in 10-yr survival. These results suggest that the Crohn's-like reaction around colorectal carcinomas may be a favorable host response, similar to lymphocytic infiltrates at the advancing tumor edge. Analysis of more cases should clarify whether this CLR is independent of other variables.
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PMID:Crohn's-like lymphoid reaction and colorectal carcinoma: a potential histologic prognosticator. 236 40

A 60-year-old woman had progressive lower abdominal pain, nonbloody diarrhea, and weight loss, followed by severe epigastric pain and dysphagia. Radiographic evaluation of the colon showed segmental strictures which were interpreted as Crohn's disease. Medical treatment was not helpful. Neither gross endoscopic appearance nor multiple biopsies of the esophagus, stomach, and colon were diagnostic. Finally, laparotomy with full-thickness biopsies of the stomach and colon revealed linitis plastica. The clinician should be alert to colonic metastases from gastric linitis plastica, for it can produce focal or segmental strictures, mimicking more common colonic diseases such as Crohn's disease. A full-thickness biopsy is often necessary for a firm diagnosis. We review the literature on this occurrence, highlighting the clinical and radiologic spectrum, as well as the organ systems most often affected when gastric linitis plastica metastasizes.
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PMID:Gastric linitis plastica with metastases to the colon: a mimic of Crohn's disease. 255 55

Metastatic malignancies are able to imitate the radiological or intraoperative findings of Crohn's disease. Being of great importance in individual cases, the manifestation of intestinal metastases mimicking Crohn's disease is analysed. Since 1960 world literature has reported intestinal metastases simulating Crohn's disease in 19 patients. Primary tumours were breast cancer (13 patients), gastric cancer (5 patients) and unknown primary focus (1 patient), in which even postmortem examination failed to reveal the site of primary cancer. 12 (67%) of 18 specified patients showed metastatic infiltration of the terminal ileum. Long segments of narrowing were found in all patients. Since specific signs such as age, sex, localization or macroscopic appearance to differentiate Crohn's disease from metastatic tumour spread are lacking, a histological examination is necessary to establish the correct diagnosis. The median survival time was approximately one year following the intestinal tumour spread.
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PMID:[Differential diagnosis of Crohn disease: segmental intestinal metastasis of breast and stomach cancer]. 273 92

Four years after mastectomy for a scirrhous carcinoma a 71-year-old woman developed diarrhoea. Crohn's disease was suspected. At endoscopy a stenosis of the sigmoid colon was found which could not be passed: the mucosa was normal looking. Gastrointestinal radiography revealed segmental subtotal stenoses of the colon with linitis plastica, typical for tumour-caused infiltration, as well as indentations in the small intestine by mesenteric metastases. The diagnosis was confirmed by computed tomography and, finally, operation. Chemotherapy failed to produce any regression of the colon stenoses, and the patient died from mechanical ileus. In case of a similar history and colon stenoses of uncertain aetiology the possibility of intestinal metastases should be considered in the differential diagnosis.
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PMID:[Segmental colonic stenosis in intestinal metastasis of breast carcinoma. A contribution to the differential diagnosis of colitis]. 283 27

The CT scans in 25 patients without ileocecal pathology and 52 patients with ileocecal abnormalities were retrospectively reviewed. The ileocecal region was identified in 18/25 (72%) of patients without pathology. Thirty of 52 patients with ileocecal pathology had inflammatory disease: Crohn's (13), appendicitis (9), abscess (6), and typhlitis (2). CT was complementary to barium studies, demonstrating wall thickening, pericolonic inflammatory change, masses, fascial thickening, and fistulae. Twenty patients had malignancy: primary carcinoma (9), metastases (7), and lymphoma (4). In all patients with carcinoma a mass was identified. Pericolonic stranding represented tumor extension in 5/6 patients. Metastases were identified as extrinsic ileocecal masses in all 7 patients. Liver, mesenteric and omental metastases were present in 8/20 patients. In patients with lymphoma there was wall thickening and two had additional pericecal lymphadenopathy. In 2 patients with hypoalbuminemia, findings included: wall thickening, mesenteric, and subcutaneous edema.
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PMID:Computed tomography of the ileocecal region. 317 84


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