Thursday, May 31, 2007

path updates

Unfortunately my right hemicolectomy/whipple guy has a T4N2 poorly differentiated adenocarcinoma. Several of the nodes, moreover, had extracapsular extension. Obviously not the ideal result. I sat with him and his wife, telling them the news. I appreciate that you don't bullshit me, doc, he said. My father died of colon cancer when he was 79, he went on, his voice cracking. He seems to know what the score is.

My lady with the obstructing colon CA interestingly ended up with a likely metastatic lesion from a breast primary (probably infiltrating lobular). She was successfully treated 9 years ago with MRM and post-op chemo. The literature is a little sparse, but breast metastases to the colon have been described. I think this finding explains the foreshortened mesentery/desmoplastic reaction I encountered during the resection. I had GU place ureteral catheters prior to starting and it probably saved my ass. The left ureter was stuck to thickened, fibrotic sigmoid mesentery and I would have had a hard time identifying it without them. She's actually progressing nicely.

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