A. Peptic Ulcer.
B. Esophageal Carcinoma.
C. Colorectal Carcinoma.
D. Intestinal Obstruction.
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.
The appearance of the apple-core lesion of the colon also can be caused by other diseases :
- lymphoma with colonic involvement – appears more diffuse
- Crohn’s disease
- chronic ulcerative colitis
- ischaemic colitis
- Chlamydia infection
- colonic tuberculosis
- colonic amoebiasis
- colonic cytomegalovirus
- villous adenoma
- It is the most common cancer of the gastrointestinal tract.
Recognised hereditary syndromes are seen in 6% of colorectal carcinomas. These include:
- familial adenomatous polyposis syndrome .
- Gardner syndrome variant
- Turcot syndrome variant
- Peutz-Jeghers syndrome
- hereditary non-polyposis colon cancer syndrome .
- Clinical presentation is typically insidious, with altered bowel habit or iron deficiency anaemia from chronic occult blood loss.
- Colorectal cancers, 98% of which are adenocarcinomas, arise in the vast majority of cases from pre-existing colonic adenomas (neoplastic polyps).
Colorectal cancers can be found anywhere from the caecum to the rectum, in the following distribution :
- recto-sigmoid: 55%
- caecum and ascending colon: ~20%
- ileocaecal valve: 2%
- transverse colon: ~10%
- descending colon: ~5%.
Radiographic features Barium enema
- Filling defects
- Typically they appear as exophytic or sessile masses, or may be circumferential (apple core sign)