Unusual Abscesses Associated with Colon Cancer:

Report of Three Cases

Atsushi Okita

, Yoshiro Kubo, Minoru Tanada,

Akira Kurita, and Shigemitsu Takashima
Dejor|men|ofSuryery,ShiloluConcerCen|er,Mo|suyomo710:88,Jojon
olovocial cancovs avo anong iho connon nalig-
nancios. Jypical pvosoniing synpions volaiod
io colovocial cancov includo a chango in bowol habiis
wiih incvoasing consiipaiion ov spuvious diavvhoa,
lowov abdoninal pain, poncil-shapod siool, visiblo
blood in iho siool, woaLnoss, and woighi loss [i].
Howovov, colovocial cancov doos noi always pvosoni
wiih such Ianiliav synpions [2]. !i is anoihov oI iho
gvoai iniiaiovs, and iho vaviabiliiy oI iis pvosonia-
iion is woll docunoniod [3]. ov oxanplo, loss con-
non naniIosiaiions includo povIovaiion and abscoss
Iovnaiion, which avo usually inivapoviionoal bui nay
also bo locaiod in iho oxivapoviionoal spacos [4].
Such casos oIion pvosoni wiih aiypical clinical nd-
ings and avo di culi io diagnoso accuvaioly by vadio-
gvaphic siudios. !n addiiion, a dolay in diagnosis and
inadouaio nanagononi usually aggvavaio novbidiiy
and novialiiy [4]. Wo vopovi 3 casos oI colon cancov
pvosoniing wiih unusual abscoss Iovnaiion. ow
vopovis oI ihis oniiiy havo boon publishod. Wo also
discuss iho nanagononi oI ihis unusual colon cancov
ihvough ouv oxpovionco.
C
Three cases of colon cancer accompanied by unusual abscess formation are reported. Case I : A
77-year-old man was diagnosed with a paracolic abscess formation behind the cecum and a swollen
appendix by computed tomography (CT) scan. Case II : An 85-year-old woman was diagnosed with
an abscess formation of the right iliopsoas muscle, a swollen appendix, and a thickened right colon
wall by CT scan. After antibiotic therapy failed, both patients underwent ileocecal resection urgently
under suspicion of appendicitis, but cecal cancer around the entrance to the appendix caused second-
ary appendicitis in both cases. Case III : A 50-year-old woman was diagnosed with sigmoid colon can-
cer with an abscess formation in the pelvic cavity concomitant with ovarian tumor. A Hartmann
procedure was performed, and a pathological examination revealed that a subserosal abscess behind
the sigmoid colon cancer perforated the rectum with abscess formation. All cases were denitively
diagnosed intraoperatively. The cancer recurred in cases I and III. We emphasize that precise surgi-
cal evaluation has an important role in the diagnosis of these complicated diseases. In addition, sur-
gery aords the patient the best chance of recovery, and in these advanced cases radical treatment is
recommended as early as possible.
Key words : abscoss Iovnaiion, colon cancov
Acta Med. Okayama, 2007
Vol. 61, No. 2, pp. 107113
hiip ://www.lib.oLayana-u.ac.jp/www/acia/
Copyvighi 2OO7 by OLayana Univovsiiy Modical School.
CoseBejor|
Rocoivod Apvil ii, 2OO6 ; accopiod Novonbov 27, 2OO6.

Covvosponding auihov. !hono : 8i864728iii ; ax : 8i864728ii6

-nail : hospiialCciiy.LuvashiLi.oLayana.jp (A. OLiia)
Case Report

A 77-yoav-old nan was adniiiod io a

hospiial wiih a 4-day hisiovy oI Iovov and abdoninal
pain. Appondiciiis ov divoviiculiiis was suspociod.
Aniibioiic ihovapy Iov 7 days did noi inpvovo iho
paiioni`s condiiion. Movoovov, cavcinoonbvyonic
aniigon was olovaiod io i4.O ng/nl (novnal
vango : loss ihan 2.5 ng/nl). von ihoso vosulis, an
iloococal nalignancy was suspociod io havo causod
ihis povsisioni inannaiion, and iho paiioni was
voIovvod io ouv hospiial. A physical oxaninaiion
showod ihai iho vighi lowov abdonon was iondov.
Labovaiovy daia showod a whiio blood coll (WLC)
couni oI iO,9OO/nn
3
(novnal vango : 3,5OO8,5OO/
nn
3
), and a C voaciivo pvoioin (CR!) lovol oI
i7.63 ng/dl (novnal vango : loss ihan O.3 ng/dl). A
CJ scan vovoalod a ihicLonod cocun wall, a swollon
appondix, and iho spvoad oI inannaiion io iho pava-
colonic Iai iissuo wiih abscoss Iovnaiion bohind iho
cocun ov asconding colon (ig. iA, L). An appondi-
ciiis causod by nalignancy was highly suspociod, and
onovgoncy lapavoiony was povIovnod. Jho cocun
wall and iho voivopoviionoun wovo ihicLonod, and
iho abscoss Iovnaiion was locaiod boiwoon iho vighi-
sidod colon and iho voivopoviionoun. !loococal vosoc-
iion conbinod wiih lynph nodo dissociion and paviial
vosociion oI iho vonal Iascia was povIovnod. Jhovo
wovo no disiani noiasiasos, and iho losion was con-
ploioly oxcisod. Jho vosociod spocinon coniainod a
cocal iunov ihai had obsivuciod iho onivanco io iho
appondix and ihai had causod appondiciiis (ig. iC).
Culiuvos oI iho abscoss uid yioldod Pro|eusvulyoris,
Prevo|ellolivio, and Ilovoloc|eriumsjecies. A wound
abscoss and hovniaiion dovolopod on iho 5 ih posiop-
ovaiivo day (!OD). Jho paiioni undovwoni suvgovy
Iov an abdoninal hovnia on iho 24 ih !OD. Howovov,
iho wound bocano also inIociod and sponianoously
oponod, and iho paiioni`s dischavgo was dolayod uniil
iho 55 ih !OD. A paihological oxaninaiion showod a
nodovaioly diovoniiaiod adonocavcinona, ulcovaiod
iypo wiih a cloav navgin, wiih subsovosal invasion
and nodal involvononi classiod as siago
!!!L : J3NiMO accovding io iho JNM classicaiion.
On a Iollow-up oxaninaiion 6 nonihs aIiov iho opova-
iion, a CJ scan vovoalod nuliiplo livov noiasiasos,
and ivoainoni wiih 5`-dooxy-5-uovouvidino was
bogun. Nino nonihs aIiov iho iniiial opovaiion, a iho-
vacic aoviic anouvysn and pnounonia occuvvod and
iho paiioni vocoivod consovvaiivo cavo, bui soon
ihovoaIiov did noi visii ouv hospiial.
108 Acta Med. OkayamaVol. 61, No. 2 Okita et al.
A
B
C
Fig. 1Case I
A, An abscess between the ascending colon and the
retroperitoneum (arrow) ; B, The appendix was swollen (arrow) ; C,
A cecal tumor at the entrance to the appendix in the resected
specimen (arrow).

. An 85-yoav-old wonan visiiod a hospi-

ial wiih a 4-day hisiovy oI an abdoninal nass. A
iunov in iho vighi lowov abdonon wiih invasion oI
adjaconi ovgans was idoniiod on a CJ scan, and iho
paiioni was voIovvod io ouv hospiial. A physical
oxaninaiion vovoalod a iondov, localizod nass in iho
vighi lowov abdonon. Labovaiovy daia showod a
WLC couni oI iO,3OO /nn
3
and a CR! oI i8.74 ng/
dl. A CJ scan vovoalod a low-donsiiy avoa in iho
swollon vighi iliopsoas nusclo acconpaniod by an
incvoasod donsiiy oI suvvounding Iai iissuo and a
swollon appondix. !n addiiion, iho wall oI iho ascond-
ing colon was ihicLonod wiih a spiculaiod coniouv
(ig. 2A, L). Locauso acuio appondiciiis ov divov-
iiculiiis wiih vighi ilioposoas abscoss Iovnaiion was
suspociod, ivoainoni wiih IosIonycin was siaviod
innodiaioly. Howovov, iho paiioni`s condiiion doio-
viovaiod. Jwo days aIiov adnission, a Iollow-up CJ
scan vovoalod iho swolling oI iho vighi iliopsoas nus-
clo was aggvavaiod wiih gas and polycysiic pavis.
luid was also collociing in iho Douglas pouch. Jho
abscoss bocano nuliiloculav and di culi io dvain
povcuianoously, and iho paiioni innodiaioly undov-
woni lapavoiony. An abscoss Iovnaiion was Iound in
iho voivopoviionoun and iliopsoas nusclo, which
wovo incisod and oponod. !loococal vosociion wiih
lynph nodo dissociion was povIovnod bocauso oI
sovovo inannaiion oI iho cocun wiih lynphadonopa-
ihy. Jho vosociod spocinon vovoalod a iunov ai iho
baso oI iho appondix, which had inducod socondavy
appondiciiis and abscoss Iovnaiion (ig. 2C).
Culiuvos oI iho abscoss yioldod S|rej|ococcus,
Prevo|ello luccoe, and Boc|eroides |he|oio|oomicron.
Jhovo wovo no nalignani colls in iho poviionoal ou-
sion. Jho posiopovaiivo couvso was unovoniIul, and
iho paiioni was dischavgod on iho ii ih !OD. A
paihological oxaninaiion showod ihai iho iunov was
a woll diovoniiaiod adonocavcinona, ulcovaiod wiih
a cloav navgin and 3.6 by 3.2 cn in sizo wiih invasion
oI non-poviionoalizod, povicolic iissuos. !i was clas-
siod as siago !!!A : J3NiMO accovding io iho JNM
classicaiion. Adjuvani ihovapy was noi povIovnod,
and iho paiioni has boon woll wiihoui any ovidonco oI
vocuvvonco Iov 3 yoavs aIiov suvgovy.

. A 5O-yoav-old wonan woni io a hos-

piial wiih a 3-day hisiovy oI Iovov. A vighi ovavian
iunov and abscoss Iovnaiion in iho Douglas pouch
wovo idoniiod on a CJ scan, and iho paiioni was
voIovvod io ouv hospiial`s dopavinoni oI gynocology.
A physical oxaninaiion showod ihai iho lowov abdo-
non was iondov. Labovaiovy daia showod a WLC
109 Unusual Abscesses with Colon Cancer April 2007
A
B
C
Fig. 2Case II
A, The swelling iliopsoas muscle included a low-density area
(arrow), and the ascending colon showed a thickened wall and a
spiculated outer margin (arrowhead) ; B, The appendix was
swollen (arrow) ; C, A cecal tumor at the entrance to the appendix
in the resected specimen (arrow).
couni oI iO,4OO/nn
3
and a CR! oI 9.52 ng/dl.
CAi25 was olovaiod io 49.3 U/nl (novnal
vango : loss ihan 35 U/nl). On CJ, an aiv-coniaining
5.5-cn-dianoiov vound nass was locaiod adjaconi io
iho signoid colon in iho polvic caviiy and was diag-
nosod wiih an abscoss (ig. 3A). !n addiiion, nag-
noiic vosonanco inaging (MR!) showod ihai a 7-cn-
dianoiov cysiic nass coniaining a solid conpononi
was Iound on iho vighi sido oI iho uiovus (ig. 3L).
An X-vay oxaninaiion oI iho lavgo iniosiino and a CJ
scan showod obsivuciion oI iho signoid colon wiih a
ihicLonod wall (ig. 3A, C). Locauso ihoso ndings
suggosiod signoid colon cancov and an ovavian iunov
wiih abscoss Iovnaiion in iho Douglas pouch, iho
paiioni was voIovvod io ouv dopavinoni 3 days laiov
and undovwoni an onovgoncy opovaiion. Jhovo was
110 Acta Med. OkayamaVol. 61, No. 2 Okita et al.
A
B
C
D
E
Fig. 3Case III
A, An abscess in the pelvic cavity (arrow), and contrast medium was tapered o at the sigmoid colon with a thickened wall close to the
abscess (arrowhead) ; B, A 7-cm-diameter cystic mass containing a solid component (arrow) ; C, An obstruction of the sigmoid colon
(arrow) and a stenosis of the rectum (arrowhead) on X-ray examination ; D, The sigmoid colon cancer involved the rectum (arrow) ; E,
The right ovary became a cystic mass containing a solid tumor diagnosed with metastasis of the sigmoid colon cancer.
iOO nl oI lighi bloody poviionoal ousion, which con-
iainod no nalignani colls. Wo Iound iho signoid
colon nass wiih povIovaiion io iho vociun and an
abscoss boiwoon iho signoid colon and iho vociun.
Jho vighi ovavy had bocono a 6-cn-dianoiov cysiic
nass. A Havinann pvocoduvo wiih lynph nodo dis-
sociion and bilaioval oophovociony was povIovnod.
xaninaiion oI iho vosociod spocinon vovoalod a
5-by-3-cn iunov povIovaiing iho vociun (ig. 3D).
Jho vighi ovavy coniainod a lighi-yollowish ivanspav-
oni uid and a 4.5-by-3.8-cn solid iunov dopiciing
noiasiasis oI iho signoid colon cancov by oxanina-
iion oI iho Ivozon spocinon (ig. 3). Culiuvos oI
abscossos yioldod - and -S|rej|ococcus, Condido
ollicons, and Ac|inomyces viscosus. A paihological
oxaninaiion showod a nodovaioly diovoniiaiod ado-
nocavcinona, an ulcovaiod iunov wiih a cloav navgin
wiih subsovosal invasion, and no lynph nodo noiasia-
sos. Jhis caso was classiod as siago !V : J3NOMi
accovding io iho JNM classicaiion. !i was osii-
naiod ihai a subsovosal abscoss dovolopod bohind iho
ulcov oI iho iunov and was covovod by boih iho sig-
noid colon and iho vociun. Jho posiopovaiivo couvso
was unovoniIul, and iho paiioni was dischavgod on
iho i5 ih !OD. Jwo nonihs aIiov suvgovy, livov and
poviionoal noiasiasos wovo discovovod by CJ scan.
Howovov, iho paiioni is alivo i yoav aIiov suvgovy,
and has shown a paviial vosponso io chonoihovapy
wiih 5-uovouvacil and l-loucovovin.
Discussion

Wo havo ivoaiod 2 paiionis wiih cocal cancov ihai

inducod appondiciiis wiih abscoss Iovnaiion and i
paiioni wiih signoid colon cancov ihai povIovaiod iho
vociun wiih abscoss Iovnaiion in iho polvic caviiy.
Ono-ihivd oI paiionis wiih colon cancov havo najov
conplicaiions, such as involvononi oI adjaconi
ovgans ov sivuciuvos, obsivuciion, ov povIovaiion [5].
Abscoss Iovnaiion, howovov, is vavo, occuvving in
O.3 io 4 oI casos oI colon cancov, bui ii is iho
socond nosi connon pvosoniaiion oI povIovaiivo
losions [6]. Michowiiz e|ol. havo pvoposod iho Iol-
lowing clinical classicaiion oI povIovaiion-conpli-
caiod cavcinona oI iho colon : i) Ivoo povIovaiion
wiih loaLago oI iho bowol conionis inio iho poviionoal
caviiy ; 2) covovod povIovaiion wiih local abscoss Iov-
naiion ; 3) povIovaiion inio ono oI iho noighboving
ovgans ov Iovnaiion oI a siula [7]. !ovIovaiion in
colon cancov occuvs connonly, duo oiihov io divoci
povIovaiion Ivon iunov nocvosis ov io pvoxinal colon
blow-oui Ivon an obsivuciod iunov and a conpoioni
iloococal valvo pvoducing a closod loop [8]. Alihough
iho nochanisn oI abscoss Iovnaiion vonains uncloav,
by ouisivipping iho blood supply, iunov gvowih nay
conivibuio io abscoss pvoduciion in iho pvosonco oI
oniovic ovganisns [3]. Suppuvaiion duo io iho loaL-
ago oI bowol conionis Ivon povIovaiod iunovs nay
load io vavious unusual pvosoniaiions, such as
voivopoviionoal, subcuianoous, and povinophvic
abscoss ; povivocial abscoss ov siula ; and acuio
appondiciiis and appondiculav abscoss [i].

Acuio appondiciiis wiih ov wiihoui abscoss Iovna-

iion is a connon disoaso. Luninal obsivuciion by a
Iocaliih ov lynphoid hypovivophy is iho nosi connon
Iaciov pvocipiiaiing acuio appondiciiis in childvon and
young adulis [9]. Cocal cancov vavoly pvosonis as
acuio appondiciiis [iO], bui nany clinicians boliovo
ihai acuio appondiciiis in an oldovly paiioni sivongly
suggosis an undovlying cocal cancov, as vsi
doscvibod by Shoavs in i9O6 [ii]. Sovoval papovs
suggosi ihai iO io 25 oI oldovly paiionis pvosoni-
ing wiih acuio appondiciiis havo an undovlying cocal
cancov as iis pvoxinaio causo [i2, i3].

Jho accuvaio pvoopovaiivo diagnosis oI abscoss

Iovnaiion volaiod io colon cancov is considovod di -
culi. Novoviholoss, iho suvgoon nusi doiovnino iho
souvco oI any abscoss as uicLly as possiblo. !n his-
iovy-iaLing ov duving a physical oxaninaiion, iho
hallnavLs oI abscoss Iovnaiion avo iho pvosonco oI
Iovov, pain, a palpablo nass, ov louLocyiosis [3],
and a nalignani nooplasn should bo suspociod in
paiionis wiih an aiypical hisiovy oI pvolongod synp-
ions, a palpablo nass, woighi loss, ov anonia [i4].
!n labovaiovy daia, iunov navLovs nay bo also uso-
Iul Iov doiociing colon cancov, bui olovaiions oI such
navLovs avo noi uniuo io colon cancov and avo noi
voconnondod io bo usod io scvoon asynpionaiic
paiionis [i5]. !n convoniional vadiogvaphic siudios,
voonigonogvans doioci indivoci signs, such as dis-
placononi oI iho uvoiov, aliovaiion oI iho psoas nav-
gin, scoliosis, ilous, abnovnal nassos, and oxivalu-
ninal gas [3, i6], ov a baviun onona nay donon-
sivaios iho nooplasn, a siulous ivaci, ov an abscoss
caviiy [3]. Colonoscopy is usoIul Iov divoci objociivo
invosiigaiion oI iho iunov Ioaiuvos, bui in ouv casos,
111 Unusual Abscesses with Colon Cancer April 2007
undov onovgoncy and dobiliiaiod condiiions, wo did
noi povIovn colonoscopy bocauso oI iho possibiliiy oI
insu cioni ivvigaiion ov iho incvoasod loaLago oI
bowol conionis. CJ scanning, bocauso oI iis oxui-
siio inaging capabiliiios, is an idoal iool Iov ovaluai-
ing suspociod abscossos, and colovocial cancov
appoavs as a discvoio nass ov Iocal wall ihicLoning.
Alihough ihoso avo nonspocic ndings [i7], CJ is
usoIul Iov pvoviding valuablo siaging inIovnaiion Iov
iho pvoopovaiivo assossnoni oI colovocial cancov [i8]
vaihov ihan as a pvinavy diagnosiic iool in iho doioc-
iion oI colonic cancov. von ihough abscossos wovo
diagnosod, convoniional vadiogvaphic inaging diagno-
sis has liniiaiions. Jhoso nonspocic signs and synp-
ions do noi allow us io diagnoso iho causos oI
abscossos, ospocially iho pvosonco oI cancov, and
nay conivibuio io a signicani dolay in diagnosis. !n
Iaci, wo wovo ablo io locaio iho iunov pvoopovaiivoly
in only ono caso !!!. spocially, whon acuio inan-
naiion oI iho appondix and cavcinona oI iho cocun
cooxisi, accuvaio diagnosis is oxivonoly di culi [ii].
!n casos ! and !!, wo had io ovaluaio iho pvosonco oI
nalignancy inivaopovaiivoly. Jho oxaci diagnosis
nusi oIion dopond on inivaopovaiivo oxaninaiions in
an uvgoni opovaiivo soiiing. Duving iho opovaiion,
ihovough ovaluaiion oI iho colovociun by palpaiion
and visualizaiion is vouivod. Howovov, bocauso oI a
liniiod suvgical old ov di culiy in oxploving
inanod avoas, a nalignani iunov nay bo nissod
ovon duving suvgovy iI wo do noi iniiially suspoci
ihai iho oxisionco oI a nalignani iunov has causod
abscoss Iovnaiion. spocially, iho inannaiovy
voaciion and iho associaiod colovocial induvaiion nay
concoal iho pvosonco oI a colovocial nass. Whon ii is
inpossiblo io diovoniiaio a bvoiic nass Ivon a noo-
plasn wiih iho naLod oyo, nicvoscopic oxaninaiion
oI Ivozon sociions nay bo usoIul. Vavious conbina-
iions oI ihoso noihods avo usually noodod io osiab-
lish a doniiivo diagnosis. !n Iaci, iho cooxisionco oI
cocal cancov and acuio appondiciiis is volaiivoly vavo,
bui ii should bo Lopi in nind in oldovly paiionis wiih
povsisioni appondiciiis. Whon pvoopovaiivo diagnosis
is uncoviain, wo voconnond cavoIully ovaluaiing and
palpaiing iho colon inivaopovaiivoly. !I iho iunov
inducod inannaiion, iho abscoss was absoluioly
Iovnod closo io iho iunov in iho inanod colon.
Novoviholoss, sinco an accuvaio diagnosis is uncov-
iain, wo voconnond innodiaioly vosociing iho
inanod colon and ovaluaiing iho spocinon. Aciually
wo povIovnod colociony in all casos and succossIully
idoniiod colon cancov inivaopovaiivoly.

!aiionis wiih colovocial cancov who pvosoni wiih

najov conplicaiions avo gonovally considovod io havo
lowov cvudo suvvival and highov opovaiivo novialiiy
vaios [5]. Michowiiz e|ol. havo vopoviod opovaiivo
novialiiy and 5-yoav suvvival vaios oI 5O and 2O,
vospociivoly, in a snall siudy oI paiionis wiih colon
cancov conplicaiod by local abscoss [7]. No lavgo
siudios havo ovaluaiod opovaiivo novialiiy, novbid-
iiy, and pvognosis in paiionis wiih colovocial cancov
conplicaiod by poviionoal abscoss. Jhis unIavovablo
pvognosis nay conivibuio io a high opovaiivo novial-
iiy vaio duo io sopsis, locally advancod nalignancy,
and a highov incidonco oI disiani noiasiasis ai pvo-
soniaiion. Conploio vosociion oI iho colon cancov
and iho abscoss wall is pvoIovablo, bui iho paiionis
avo usually old and a poov opovaiivo visL, and nosi
suvgoons havo oIion wavovod in judging whoihov io
povIovn a nininal pvocoduvo and posipono a najov
pvocoduvo uniil iho paiioni`s condiiion inpvovos ov io
povIovn najov pvocoduvo innodiaioly in lighi oI iho
opovaiivo visL [7]. Unloss suvgovy is conivaindicaiod
by iho paiioni`s gonoval condiiion, povcuianoous aspi-
vaiion and indwolling caihoiov dvainago conbinod
wiih aniibioiic ihovapy nay bo innodiaioly siaviod
wiihoui Iuvihov diagnosiic wovL-up. Howovov, iho
dvainago pvocoduvo nay alloviaio nuch oI iho iox-
onia, and conconiiani vosociion should bo cavviod
oui iI possiblo io ovadicaio iho souvco oI sopsis [3].
!n oxionsivo sopsis, anasionosis oI iho colon nay bo
visLy, and a siagod pvocoduvo is oIion voconnondod.
voonan e| ol. havo voconnondod ihai povIovaiivo
colon cancov wiih abscoss Iovnaiion is bosi ivoaiod
wiih a pvolininavy ioially divoviing colosiony and
local dvainago oI iho abscoss wiih iho uso oI appvo-
pviaio aniibioiics ; oihovwiso, povIovaiod cocal can-
cov is noi anonablo io a pvoxinal divoviing colos-
iony, in which caso, pvinavy vosociion oI iho vighi
colon wiih adouaio dvainago is voconnondod [i9].
Wiih voconi advancos, Iaciovs such as povIovaiion,
poviioniiis, and pus avo noi conivaindicaiions io pvi-
navy opovaiion. !vinavy vosociion and anasionosis
Iov povIovaiod loIi colon losion can also bo saIoly
povIovnod ovon in iho pvosonco oI poviioniiis in
solociod paiionis [2O]. von whon paiionis suvvivo
suvgovy, inconploio iunov cloavanco nay incvoaso
112 Acta Med. OkayamaVol. 61, No. 2 Okita et al.
iho visL oI local vocuvvonco in advancod casos.
Aciually, wo could havo povIovnod conploio oxcision
oI iho iunov losion, bui all 3 casos wovo advancod
and had a high visL oI vocuvvonco. !oviionoal vocuv-
vonco dovolopod in caso !!!, and livov noiasiasis
dovolopod in casos ! and !!! aIiov iho opovaiion. On
iho oihov hand, ihovo was no vocuvvonco in caso !!.
Caso !!! alvoady had synchvonous ovavian noiasiasis,
and vocuvvonco was povhaps inoviiablo. Jho sovoviiy
oI inannaiion nay noi bo volaiod io iho pvognosis.
Snoihovs e| ol. in a snall siudy vopoviod ihai iho
nogaiivo ooci oI onovgoncy suvgovy on ouicono nay
bo liniiod io iho poviopovaiivo poviod and in iho
ovovall suvvival Iov paiionis who suvvivod suvgovy,
iho suvvival vaio Iov paiionis undovgoing onovgoncy
suvgovy was ouivaloni io ihai Iov paiionis undovgo-
ing olociivo suvgovy [2i]. !n addiiion, iho suvvival
iino is noi inuoncod by iho iypo oI povIovaiion bui
is inuoncod by iho siago oI iunov invasion [7]. !I
possiblo, a najov pvocoduvo Iov conploio vosociion
should bo povIovnod.

!n conclusion, wo havo ivoaiod ihvoo casos oI

colon cancov wiih unusual abscoss Iovnaiion.
Accuvaio pvoopovaiivo diagnosis oI ihoso oniiiios is
oxivonoly di culi dospiio voconi dovolopnonis in
inaging iochniuos. Howovov, ii is inpoviani io
Iocus on a diovoniial diagnosis, including colon can-
cov by conbinaiions oI diagnosiic nodaliiios, io sono
oxioni pvoopovaiivoly. spocially, CJ scans
vovoalod all aspocis oI colon losions and wovo usoIul
Iov assossing iho siaius oI abscossos, bui oxaci diag-
nosos wovo possiblo only duving suvgovy aIiov all,
and wo voconnond vosociing iho inanod colon and
innodiaioly ovaluaiing iho spocinon. !n paiionis wiih
povsisioni abscoss Iovnaiion, iho conconiiani pvos-
onco oI colon cancov nusi bo considovod. !n iho lighi
oI high invasivonoss, vadical ivoainoni is vocon-
nondod as oavly as possiblo iI ihovo avo no disiani
noiasiasos ov poviionoal dissoninaiions.
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