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Pelvic: Right adnexal or colonic mass measuring 6 x 5 cm that is solid on ultrasound. Rule out colon or gyn malignancy.
CT abdomen: Moderate amount of right and small amount of left pleural effusion. Multiple poorly marginated rounded areas of decreased density measuring up to 6 cm in diameter involving both right and left lobes of liver considered due to metastatic disease.
Chest: Patchy reaction at right base posteriorly and questionable small patchy inflammatory infiltrate at right posterior base.
CEA: 15.8 (normal 0.0 - 3.0)
Alk Phos: 317 (normal 69 - 241)
Partial sigmoid colectomy: Mass in midline attached to bladder and to a loop of small bowel. Large mass encompassing sigmoid. Multiple masses in mesentery. Metastases measuring 4 x 6 cm in right lobe of liver.
Gross: Partial sigmoid colon.
Micro: Necrotic mod diff adenoca. 7.5 cm centrally necrotic invasive mod diff adenoca extending through wall into pericolonic soft tissues with extension to serosal surface. Metastases to 5/18 mesenteric nodules. Sigmoid margins free of neoplasm. Neoplasm appears to arise within villoglandular adenoma.
Surgery: Partial sigmoid colectomy.
Chemotherapy: Began FOLFIRI regimen (folic acid, 5-FU, irinotecan).