Sigmoid cancer in a diverticulum (a case report and review)

AIM: to present and discuss the challenges of radiological and endoscopic diagnosis of cancer within a colonic diverticulum in patients with diverticulitis, using a clinical case as an example.

PATIENTS AND METHODS: a 76-year-old female patient underwent clinical and instrumental examination for exacerbation of sigmoid diverticular disease.

RESULTS: based on the findings of radiological and endoscopic examinations, a chronic pericolonic inflammatory infiltrate of the sigmoid colon involving the uterine stump was identified, showing signs of neoplastic growth within a diverticulum, as well as a tumor in the ascending colon. The patient underwent simultaneous right hemicolectomy and combined anterior resection of the rectum with extirpation of the uterine stump. Pathomorphological examination revealed a poorly differentiated adenocarcinoma with signs of impaired DNA mismatch repair (dMMR) within the diverticulum, and a tumor in the ascending colon with similar characteristics.

CONCLUSION: cancer arising in a colonic diverticulum presents a complex diagnostic challenge due to its unique growth patterns and the need to differentiate it from complicated forms of diverticular disease. In such cases, a thorough and comprehensive clinical and instrumental examination is necessary for adequate planning of surgical treatment.

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