A 60-Year-Old Woman with a Cecal Lesion Seen on Colonoscopy

A 60-year-old woman presented for routine screening colonoscopy following referral by her primary care physician. The patient was asymptomatic at the time. She was healthy with no medical conditions and took no medications. Colonoscopy was unremarkable with the exception of a submucosal lesion seen in the cecum that extrinsically compressed and partially obscured the appendiceal orifice (Figure 1). Multiple endoscopic biopsy specimens of the overlying cecal mucosa were taken, but these demonstrated normal colonic mucosa. Laboratory study results were normal, including a complete blood count with differential, electrolytes, liver function tests, and carcinoembryonic antigen (CEA). The patient was then referred for a computed tomography (CT) scan of the abdomen/pelvis with oral and intravenous contrast. CT revealed an irregular, tortuous, fluid-filled, tubular-shaped structure that partially compressed the cecum. This structure measured approximately 2 cm wide in the region of the cecum to 1 cm in the region of the blind-ending tip, which descended into the pelvis (Figure 2). The liver, gallbladder, spleen, pancreas, small bowel, and kidneys were all normal. No lymphadenopathy was visualized.