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Mass-Forming NSAID-Associated Colopathy Mimicking Right-Sided Colon Cancer: A Case Report
Hong Yu1, Sonalben L Italiya1, Hongbo Wang2
1Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA, bcm.edu.
Abstract:
Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause mucosal injury throughout the gastrointestinal tract, yet NSAID-related colonic damage remains underrecognized. We report a rare case of an ulcerated colonic mass mimicking carcinoma in a patient with long-term NSAID exposure. The patient, a 63-year-old man with a history of coronary artery disease and coronary artery bypass grafting more than 25 years earlier, was receiving long-term dual antiplatelet therapy consisting of aspirin (81 mg daily) and clopidogrel (75 mg daily), as well as chronic pantoprazole therapy. He presented with a 4-day history of hematochezia without weight loss. Esophagogastroduodenoscopy revealed no bleeding source, but colonoscopy identified an ulcerated, nonobstructive mass in the cecum and proximal ascending colon. A biopsy revealed colonic mucosa with severe ulceration and granulation tissue. The subsequent right hemicolectomy specimen revealed a 5.5-cm, ill-defined ulcerative mass in the cecum and ascending colon. Microscopically, the cecum and ascending colon showed ulcerated mucosa with fibrosis, reactive changes, and foreign body material deposition, without evidence of malignancy. Immunohistochemical stains for cytomegalovirus (CMV) and herpes simplex virus (HSV) were negative. Following surgery, aspirin and clopidogrel were resumed because of the patient's cardiovascular risk. Approximately 1 year later, his hemoglobin level was 12.0 g/dL (6.7 g/dL before surgery), and no gastrointestinal bleeding, diarrhea, or abdominal pain was documented during that encounter. Because aspirin was continued, a clinical response to medication withdrawal could not be assessed. Based on the medication history, right-sided distribution, and histologic findings, the lesion was considered most consistent with suspected aspirin-associated colopathy presenting as a mass-like lesion. However, the concomitant clopidogrel and pantoprazole use and the absence of a formal aspirin dechallenge limited definitive causal attribution.
Insights
A rare case of a colonic mass mimicking cancer was linked to long-term Nonsteroidal anti-inflammatory drug (NSAID) use. This aspirin-associated colopathy highlights underrecognized NSAID-induced gastrointestinal damage.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Pharmacology
Background:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to cause gastrointestinal mucosal injury.
- NSAID-induced colonic damage is often underrecognized, presenting diagnostic challenges.
- Long-term NSAID use, particularly aspirin, is associated with various gastrointestinal complications.
Purpose of the Study:
- To report a rare case of an ulcerated colonic mass mimicking carcinoma in a patient with long-term NSAID exposure.
- To discuss the diagnostic considerations and potential etiology of NSAID-associated colonic lesions.
- To highlight the importance of considering medication history in the evaluation of colonic masses.
Main Methods:
- Case report of a 63-year-old male patient with long-term dual antiplatelet therapy (aspirin and clopidogrel).
- Diagnostic workup included esophagogastroduodenoscopy and colonoscopy with biopsy.
- Surgical intervention with right hemicolectomy and histopathological examination of the resected specimen.
Main Results:
- Colonoscopy revealed an ulcerated mass in the cecum and ascending colon, initially mimicking malignancy.
- Histopathology confirmed severe ulceration, fibrosis, and reactive changes, but no evidence of malignancy.
- The lesion was deemed most consistent with suspected aspirin-associated colopathy, despite limitations in definitive causal attribution.
Conclusions:
- NSAID-associated colopathy can present as a mass-like lesion, potentially mimicking colorectal cancer.
- Thorough medication history, including long-term NSAID use, is crucial for diagnosing such conditions.
- While this case suggests aspirin as the likely culprit, further studies are needed to fully elucidate NSAID-induced colonic pathology.
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