An unusual initial presentation of colorectal cancer: abdominal wall and scrotal abscess associated with right ventricular metastasis

Abstract

A 56-year-old man presented to the emergency department with a painful abdominal lump with redness of the overlying skin in the right iliac fossa, swelling, and redness of the scrotum. Laboratory tests revealed a marked increase in white blood cell count (50.73x109/L), neutrophil count (48.18x109/L), and C-reactive protein levels (37.36 mg/dL). Abdominal contrast-enhanced Computed Tomography (CT) scan showed a voluminous neoplastic lesion involving the ascending colon, the cecum, and the last ileal loop, which was in communication with a large abscess located in the anterior abdominal wall and extended craniocaudal up to the right scrotum; a mass within the right ventricle was also seen. The patient underwent a right hemicolectomy and a right orchiectomy. Histological examination revealed a low-grade mucinous adenocarcinoma of the right colon as well as a significant abscess of the right testis' tunica vaginalis. The patient died one month after surgery.

Keywords

• Colorectal cancer
• abdominal wall abscess
• scrotal abscess
• cardiac metastasis
• computed tomography