Question
A 70 year old male presented with iron deficiency anemia and occult blood loss in stool and indigestion.Barium Enema showed the following features.What can be the most probable diagnosis?
A. Peptic Ulcer.
B. Esophageal Carcinoma.
C. Colorectal Carcinoma.
D. Intestinal Obstruction.
Show Answer
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Correct Answer » C
Explanation
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Ans:C. Colorectal Carcinoma.
Barium Enema in the image shows Apple Core lesion.
Apple core sign, also known as a napkin ring sign (bowel)
- It is most frequently associated with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma.
Differential diagnosis
The appearance of the apple-core lesion of the colon also can be caused by other diseases :
- lymphoma with colonic involvement – appears more diffuse
- chronic ulcerative colitis
Colorectal carcinoma
- It is the most common cancer of the gastrointestinal tract.
Associations:
Syndromes
Recognised hereditary syndromes are seen in 6% of colorectal carcinomas. These include:
- familial adenomatous polyposis syndrome .
- Gardner syndrome variant
- Turcot syndrome variant
- hereditary non-polyposis colon cancer syndrome .
Clinical presentation
- Clinical presentation is typically insidious, with altered bowel habit or iron deficiency anaemia from chronic occult blood loss.
Pathology:
- Colorectal cancers, 98% of which are adenocarcinomas, arise in the vast majority of cases from pre-existing colonic adenomas (neoplastic polyps).
Location:
Colorectal cancers can be found anywhere from the caecum to the rectum, in the following distribution :
- caecum and ascending colon: ~20%
Radiographic features Barium enema
- Typically they appear as exophytic or sessile masses, or may be circumferential (apple core sign)
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