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CT of Patients with Right-Sided Colon Cancer and Distal Ileal Thickening

Ah Young Kim1, Hyun Kwon Ha1, Bo Kyoung Seo1, Eun-Sil You2, Kyoung Sik Cho1, Pyo Nyun Kim1, Moon-Gyu Lee1, Hoon Yong Jeong3, Suck Kyun Yang3 and Young II Min3

1 Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-Dong, Songpa-Ku, Seoul, 138-736, Korea.
2 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea.
3 Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea.



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  		Fig. 1A. —70-year-old man with right-sided colon cancer invading distal ileum. Contrast-enhanced CT scan shows homogeneous enhancement of distal ileal wall thickening (straight arrow) and mesenteric vascular engorgement (curved arrow), which is associated with polypoid mass (m) involving ascending colon and cecum.

 


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  		Fig. 1B. —70-year-old man with right-sided colon cancer invading distal ileum. Contrast-enhanced CT scan shows moderate pericolic infiltration (solid arrows) and continuous concentric distal ileal wall thickening (open arrows).

 


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  		Fig. 1C. —70-year-old man with right-sided colon cancer invading distal ileum. Photomicrograph of histopathologic specimen of distal ileum shows subserosal tumor invasion (arrows) from primary colon cancer (C) and prominent submucosal edema (SM). (H and E, x 100)

 


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  		Fig. 2A. —63-year-old man with right-sided colon cancer spreading to distal ileum. Contrast-enhanced CT scan shows infiltrative right-sided colon cancer (M), which is accompanied by heterogeneous enhancement of distal ileal wall thickening (arrows).

 


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  		Fig. 2B. —63-year-old man with right-sided colon cancer spreading to distal ileum. Contrast-enhanced CT scan shows targetlike enhancement pattern of thickened distal ileum (arrows).

 


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  		Fig. 2C. —63-year-old man with right-sided colon cancer spreading to distal ileum. Photomicrograph of histopathologic specimen of distal ileum reveals subserosal lymphatic spread of tumor cells (arrow) and marked subserosal edematous swelling (SS). Note lymphoid follicle (F). (H and E, x 10)

 


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  		Fig. 3A. —63-year-old man with right-sided colon cancer invading distal ileum. Contrast-enhanced CT scan shows infiltrative cecal tumor invading ileocecal valve (curved arrow). Note ileocecal necrotic lymphadenopathy (solid arrows) and mesenteric vascular engorgement (open arrow).

 


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  		Fig. 3B. —63-year-old man with right-sided colon cancer invading distal ileum. Contrast-enhanced CT scan shows contiguous irregular bowel wall thickening of adjacent distal ileum (arrows) beyond ileocecal valve with small-bowel obstruction (asterisk). Pathology report of resected distal ileum after surgery revealed direct tumor invasion from cecal tumor through thickness of small-bowel wall.

 


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  		Fig. 4A. —58-year-old man with cecal tumor invading distal ileum. Contrast-enhanced CT scan shows cecal mass (C) invading ileocecal valve (curved arrow) and engorged ileocecal vessels (open arrows).

 


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  		Fig. 4B. —58-year-old man with cecal tumor invading distal ileum. Contrast-enhanced CT scan shows targetlike layered enhancement of distal ileal wall thickening (arrows) and small-bowel obstruction (asterisk).

 


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  		Fig. 4C. —58-year-old man with cecal tumor invading distal ileum. Photomicrograph of histopathologic specimen of thickened distal ileal segment reveals lymphatic permeation (arrows) by carcinoma cells in all layers, including submucosal (sm), subserosal (ss), and muscular (m) layers. (H and E, x 100)

 


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  		Fig. 5A. —60-year-old woman with cecal cancer and obstructive ischemic ileitis. Contrast-enhanced CT scan shows cecal mass (M) invading ileocecal valve (arrow).

 


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  		Fig. 5B. —60-year-old woman with cecal cancer and obstructive ischemic ileitis. Contrast-enhanced CT scan reveals irregular distal ileal wall thickening (arrows), which shows homogeneous enhancement.

 


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  		Fig. 5C. —60-year-old woman with cecal cancer and obstructive ischemic ileitis. Resected specimen shows cecal mass (M) invading ileocecal valve (arrow) with submucosal edema and patchy congestion of distal ileum (IL). No evidence of microscopic cancer—cell infiltration into small-bowel segment was seen.

 

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