Adenocarcinoma Complicating Ulcerative Colitis Presenting as Multiple Pseudopolyp-like Lesions


A 26-year-old man with 9 years of ulcerative colitis presented with fever, weight loss, and a 6-cm retroperitoneal mass located adjacent to the transverse colon that was detected by a computed tomography scan. Colonoscopies at year 4 and 7 of his disease revealed moderately active chronic pancolitis without dysplasia. He was maintained on mesalamine and intermittent corticosteroids. During the previous 2 months, he experienced 10 bloody bowel movements per day, abdominal cramping, and 30-pound weight loss.

On admission, physical examination revealed a thin man in mild distress with a firm mass noted in the periumbilical area. Abnormal laboratory test results included a white blood cell count of 35,000 cells/mm3, hematocrit of 28%, and a platelet count of 1,151,000 cells/mm3. A computed tomography–guided biopsy of the pericolic mass revealed poorly differentiated adenocarcinoma. Colonoscopy was attempted but was aborted at the level of the descending colon because of abdominal pain. However, the endoscopist noted multiple polypoid lesions, which were thought to represent inflammatory pseudopolyps, throughout the left colon (Figure A).

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