Colorectal cancer differential diagnosis: Difference between revisions

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Revision as of 00:24, 27 January 2019

To view the differential diagnosis of familial adenomatous polyposis (FAP), click here
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Qurrat-ul-ain Abid, M.D.[3]

Overview

Colorectal cancer must be differentiated from other diseases that cause unexplained weight loss, unexplained loss of appetite, nausea, vomiting, diarrhea, anemia, jaundice, and fatigue, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hemorrhoids, anal fissures, and diverticular disease. There are less common conditions that may be confused as colorectal cancer such as infectious colitis and gastrointestinal lymphoma.

Colorectal Cancer Differential Diagnosis

Colorectal cancer must be differentiated from other diseases that cause lower abdominal pain and fever like appendicitis, diverticulitis, inflammatory bowel disease, cystitis, and endometritis.^[1]^[2]^[3]^[4]^[5]^[6]

Other conditions that can be mistaken for colorectal cancer include the following:

	Symptoms					Lab Findings	Imaging			Histopathology
Diseases	Clinical manifestations					Para-clinical findings					Gold standard
	Symptoms					Para-clinical findings
	Bowel frequency	Blood in stool	Abdominal pain	Tenesmus	Other symptoms	Anemia	Colonoscopy	CT scan	Other diagnostic study	Histopathology
Colorectal carcinoma (Adenocarcinoma)^[7]	↑ or ↓	+	+/-	+	Weight loss Fatigue Low caliber of stools Mucus in stools	+	Polyps (villous, tubular, tubulo-villous) Ulcerating polyps Cancerous lesions	Luminal narrowing Bowel obstruction Thickening of the bowel wall Lymphadenopathy Metastases	PET scans Metastasis Barium enema Cancer or precancerous polyp	Different grades of differentiation of glandular structures Sheets or cords of malignant cells Cellular atypia and pleomorphism High mitotic rate Necrotic debris in glandular lumina Desmoplastic reaction (sign of invasion)	Biopsy, genetic testing, and histopathological analysis
Peutz-Jeghers syndrome ^[8]^[9]^[10]^[11]^[12]	↑ or ↓	+	+	-	Weight loss Fatigue Mucocutaneous hyperpigmentation Rectal prolapse	+	Multiple polyps Mucocutaneous pigmentation	Multiple polyps Intussusception Bowel obstruction	Barium enema Multiple polyps MRI Multiple hamartomatous polyps	Hamartomatous mucosal polyps with core of smooth muscle associated with mucosa Smaller polyps lack the prominent arborizing smooth muscle	Genetic testing for STK11 and colonoscopy
Carcinoids ^[13]^[14]^[15]^[16]^[17]	↑	+/-	+	-	Weight loss Weakness Flushing Wheezing Shortness of breath Palpitations Leg edema	+	Infiltrating, ulcerating or fungating lesions in the wall of colon	Well-defined single/multiple lesions Round/ovoid in shape Variable in size between 2-5 cm	PET scan (11C-5-hydroxytryptophan, 11C-5-HTP) Detects metastasis MRI Nodular mass Wall thickening Metastasis Ki-67 index	Solid/spongy nests of cells accentuated by neatly outlined luminal spaces Peripheral nuclear palisading Granular eosinophilic cytoplasm	Biopsy and histopathological analysis
Juvenile Polyposis Coli^[18]^[19]^[20]^[21]^[22]	↑	+	+	-	Prolapsing polyp Intussusception Macrocephalus Hypotonia Bowel obstruction Heart or brain abnormalities Cleft palate Polydactyly Genitalia or urinary abnormalities	+	>5 juvenile polyps in the colon and rectum Multiple juvenile polyps in gastrointestinal tract	Multiple polyps in GI tract	Barium study Multiple polyps in GI tract Stool DNA test SMAD4 or BMPR1A Diagnose if any of the following positive: More than five juvenile polyps of the colorectum Multiple juvenile polyps throughout the GI tract Any number of juvenile polyps and a family history of juvenile polyposis Heterozygous pathogenic variant in SMAD4 or BMPR1A	Cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils Lamina propria edematous with associated lymphocytes, plasma cells, eosinophils, and neutrophils Filiform, multilobed forms with increased glandular-to-stroma ratio in nonclassic or atypical polyps Areas of conventional dysplasia	Diagnostic criteria fulfilment
Gastrointestinal Stromal Tumors (GIST)^[23]^[24]^[25]^[26]^[27]	-	+/-	-	-	Asymptomatic Early satiety Bloating	+/-	Subepithelial round masses Smooth margins Normal overlying mucosa may be intact or ulcerated Bulging into gastrointestinal lumen	Benign Small, < 10 cms Homogeneous Clear boundaries intraluminal or extraluminal growth Malignant GIST with metastasis: Size > 10 cm Calcifications Irregular margins Heterogeneous and lobulated Lymphadenopathy Ulceration Extraluminal and mesenteric fat infiltration	Endoscopic ultrasonography Benign: Mucosal ulceration or bleeding Smooth submucosal mass as hypoechoic mass Malignant GIST: Heterogeneous mass >4 cm in size Irregular borders Intra/extraluminal growth Multiple cysts	Spindle cell type are eosinophilic cells arranged in the form of whorls or fascicles^[28]^[29] Epithelioid GISTs are rounded cells with oval nuclei and vesicular chromatin and appears nested On immunohistochemical staining they are positive for molecular markers CD117 antigen and KIT protein	Endoscopic ultrasound biopsy and histopathological analysis
Hamartoma^[30]	↑	+	+	+	N/A	-	Large polypoid mass	Isodense/hypodense solid masses Heterogeneous mass Presence of fat Calcification	Biopsy Proliferation of bland spindle cells in the lamina propria Mucosal Schwann cell hamartoma (MSCH)	Poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts The nuclei are bland and mostly uniform, occasional larger nuclei are found. The cytoplasmic borders are indistinct Involvement of mucosa but never the submucosa	Biopsy
Colorectal Lymphoma^[31]^[32]	-	+/-	+	-	Weight loss	+	Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions	Polypoid mass Circumferential-cavitary lesions Focal mucosal nodularity Diffuse ulcerative or nodular lesions Lymphadenopathy	Biopsy: Diffuse large B-cell lymphoma Extranodal marginal zone lymphoma (MALT) Mantle cell lymphoma Burkitt’s lymphoma Follicular lymphoma Double-contrast enema Subtle mucosal changes Gross tumor morphology	Diffuse large B-cell lymphoma: Extranodal marginal zone lymphoma (MALT) Mantle cell lymphoma Burkitt’s lymphoma Follicular lymphoma	Biopsy
Kaposi's sarcoma^[33]	↑	+	+	-	Nausea and vomiting	+	Localized purpuric lesion	N/A	Serology Antibodies against Kaposi sarcoma herpes virus (HHV-8) Biopsy Vascular proliferation, red blood cell and hemosiderin Extravasation,lymphocytes and monocytes Neovascular lesion wrapped around a pre-existing space Intracytoplasmic PAS +ve hyaline globules	Vascular proliferation RBC and hemosiderin extravasation Lymphocytes and monocytes Premonitory sign (neovascular lesion wrapped around a pre-existing space) Intracytoplasmic PAS +ve hyaline globules	Biopsy
Arteriovenous malformation^[34]	-	+	-	-	N/A	+	Bright red, flat lesions Rarely, polypoid	N/A	N/A	Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa Arteries directly connected to veins without capillary beds	Accidental finding
Diverticular diseases^[35]^[36]^[37]	↑ or ↓	+/-	+ RLQ	-	Fever Chills N/V	-	Not recommended	Outpouchings of the colonic wall (diverticula) Inflamed diverticula Abscess formation Intraperitoneal free air (microperforation)	Barium enema Circumferential narrowing Spiculated contour Tapered margins	N/A	CT scan
Hemorrhoids^[38]	↓	+	+	-	Perianal Itching Pain with defecation Painful-hard lump in anus	+	Anoscopy Protruding mass from the anus	N/A	DRE Palpable mass, tender if thrombosed	N/A	Clinical
Anal fissure^[39]	-	+	+	-	Painful defecation Itching Irritation	+/-	Anoscopy Anal wall laceration	N/A	N/A	N/A	Clinical
Infectious colitis^[40]	↑	+	+	-	Fever, chills N/V Bloating	-	Patchy or diffuse erythematous mucosa Edema, hemorrhage, with or without ulcers of mucosa	N/A	Stool cultures Stool analysis Leukocytosis	N/A	Stool culture
Ulcerative colitis^[41]V	↑	+	+ LLQ	+	Weight loss Diarrhea withmucus Urgency	+	Continuous lesions Erythema (or redness of the mucosa) and friability of the mucosa Crypts, formation of residual mucosal tissue Pseudopolyps	N/A	N/A	Mucosal and submucosal inflammation Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria Distorted crypts Crypt abscess	Endoscopic biopsy
Crohn's disease^[41]	↑	+	+ RLQ	+	N/V Bowel obstruction Fever	+	Discontinuous lesions Strictures Linear ulcerations	N/A	N/A	Transmural pattern of inflammation Mucosal damage Focal infiltration of leukocytes into the epithelium Granulomas	Endoscopic biopsy
Irritable bowel syndrome^[42]	↑ ↓	+	+	+	Weight loss Straining Urgency Mucus passage Bloating	-	Not recommended	N/A	Diagnosis of exclusion Fulfilment of Rome criteria	N/A	Clinical diagnosis (Rome criteria)
Appendicitis^[43]	↑	-	+ RLQ	-	Pain starting periumbilical before localizing to the RLQ N/V Fever Chills Loss of appetite	-	N/A	Appendiceal wall thickening (≥ 3mm) Periappendiceal fat stranding Thick lateral conal fascia and mesoappendix Extraluminal fluid Phlegmon Abscess	Ultrasound Aperistaltic, noncompressible, dilated appendix (>6 mm) Appendicolith Echogenic prominent pericaecal fat Periappendiceal fluid collection	N/A	CT scan
Strangulated hernia	↓	-	+ RLQ	-	N/V Heaviness/dull discomfort in the groin, with straining, lifting, coughing, or exercising Weakness, heaviness, burning, or aching in the groin Swelling Fever	-	N/A	Defect in the abdominal wall muscles Bowel loops within the lesion Lateral crescent sign The hernia neck superolateral to the course of the inferior epigastric vessels	Ultrasound: Hypoechoic mass suggesting dilated and edematous intestinal segment	N/A	Ultrasound
Bowel endometriosis^[44]	↑ or ↓	+	+ Pelvic	+	Dyschezia	+	N/A	N/A	Transvaginal ultrasound Heterogeneous, hypoechoic, spiculated mass T1-weighted or fat-suppression T1-weighted MRIs Contrast enhanced mass Hyperintense hemorrhagic Hyperintense cavities	N/A	Transvaginal ultrasound

References

↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
↑ Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994). "Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum". Oncology. 51 (1): 30–4. doi:10.1159/000227306. PMID 8265100.
↑ Zhong ME, Niu BZ, Ji WY, Wu B (June 2016). "Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer". World J. Gastroenterol. 22 (22): 5293–6. doi:10.3748/wjg.v22.i22.5293. PMID 27298573.
↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
↑ Giardiello, F; Trimbath, J (2006). "Peutz-Jeghers Syndrome and Management Recommendations". Clinical Gastroenterology and Hepatology. 4 (4): 408–415. doi:10.1016/j.cgh.2005.11.005. ISSN 1542-3565.
↑ Beggs, A. D.; Latchford, A. R.; Vasen, H. F. A.; Moslein, G.; Alonso, A.; Aretz, S.; Bertario, L.; Blanco, I.; Bulow, S.; Burn, J.; Capella, G.; Colas, C.; Friedl, W.; Moller, P.; Hes, F. J.; Jarvinen, H.; Mecklin, J.-P.; Nagengast, F. M.; Parc, Y.; Phillips, R. K. S.; Hyer, W.; Ponz de Leon, M.; Renkonen-Sinisalo, L.; Sampson, J. R.; Stormorken, A.; Tejpar, S.; Thomas, H. J. W.; Wijnen, J. T.; Clark, S. K.; Hodgson, S. V. (2010). "Peutz-Jeghers syndrome: a systematic review and recommendations for management". Gut. 59 (7): 975–986. doi:10.1136/gut.2009.198499. ISSN 0017-5749.
↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
↑ Chung TP, Hunt SR (May 2006). "Carcinoid and neuroendocrine tumors of the colon and rectum". Clin Colon Rectal Surg. 19 (2): 45–8. doi:10.1055/s-2006-942343. PMC 2780103. PMID 20011309.
↑ Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq
↑ Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B (May 2012). "TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study". J. Natl. Cancer Inst. 104 (10): 764–77. doi:10.1093/jnci/djs208. PMID 22525418.
↑ Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J (June 2017). "Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China". Chin J Cancer. 36 (1): 51. doi:10.1186/s40880-017-0218-3. PMC 5480192. PMID 28637502.
↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
↑ Grotsky HW, Rickert RR, Smith WD, Newsome JF (March 1982). "Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred". Gastroenterology. 82 (3): 494–501. PMID 7054044.
↑ Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ (November 2011). "Juvenile polyposis syndrome". World J. Gastroenterol. 17 (44): 4839–44. doi:10.3748/wjg.v17.i44.4839. PMC 3235625. PMID 22171123.
↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
↑ Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD (July 2004). "KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications". Am. J. Surg. Pathol. 28 (7): 889–94. PMID 15223958.
↑ Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K (November 2005). "18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors". World J Surg. 29 (11): 1429–35. doi:10.1007/s00268-005-0045-6. PMID 16222452.
↑ Miettinen M, Sobin LH, Lasota J (January 2005). "Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up". Am. J. Surg. Pathol. 29 (1): 52–68. PMID 15613856.
↑ Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
↑ Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
↑ Cauchin E, Touchefeu Y, Matysiak-Budnik T (September 2015). "Hamartomatous Tumors in the Gastrointestinal Tract". Gastrointest Tumors. 2 (2): 65–74. doi:10.1159/000437175. PMC 4668787. PMID 26672891.
↑ Quayle FJ, Lowney JK (May 2006). "Colorectal lymphoma". Clin Colon Rectal Surg. 19 (2): 49–53. doi:10.1055/s-2006-942344. PMC 2780105. PMID 20011310.
↑ Quayle, Frank; Lowney, Jennifer (2006). "Colorectal Lymphoma". Clinics in Colon and Rectal Surgery. 19 (2): 049–053. doi:10.1055/s-2006-942344. ISSN 1531-0043.
↑ Arora M, Goldberg EM (July 2010). "Kaposi sarcoma involving the gastrointestinal tract". Gastroenterol Hepatol (N Y). 6 (7): 459–62. PMC 2933764. PMID 20827371.
↑ Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS (2017). "Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review". Saudi J Gastroenterol. 23 (1): 67–70. doi:10.4103/1319-3767.199111. PMC 5329980. PMID 28139503.
↑ Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH (September 2005). "Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting". J Chin Med Assoc. 68 (9): 411–8. doi:10.1016/S1726-4901(09)70156-X. PMID 16187597.
↑ Shen, Shu-Huei; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Chiang, Jen-Huei; Chang, Cheng-Yen; Lee, Chen-Hsen (2005). "Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting". Journal of the Chinese Medical Association. 68 (9): 411–418. doi:10.1016/S1726-4901(09)70156-X. ISSN 1726-4901.
↑ Sheiman, Laura; Levine, Marc S.; Levin, Alicia A.; Hogan, Jonathan; Rubesin, Stephen E.; Furth, Emma E.; Laufer, Igor (2008). "Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings". American Journal of Roentgenology. 191 (2): 522–528. doi:10.2214/AJR.07.3597. ISSN 0361-803X.
↑ Jacobs, Danny; Solomon, Caren G. (2014). "Hemorrhoids". New England Journal of Medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. ISSN 0028-4793.
↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
↑ DuPont HL (January 2012). "Approach to the patient with infectious colitis". Curr. Opin. Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.
↑ ^41.0 ^41.1 Fakhoury M, Negrulj R, Mooranian A, Al-Salami H (2014). "Inflammatory bowel disease: clinical aspects and treatments". J Inflamm Res. 7: 113–20. doi:10.2147/JIR.S65979. PMC 4106026. PMID 25075198.
↑ Iwańczak B, Iwańczak F (August 2017). "[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]". Pol. Merkur. Lekarski (in Polish). 43 (254): 75–82. PMID 28875974.
↑ Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC (2003). "The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT". Acta Radiol. 44 (6): 574–82. PMID 14616200.
↑ Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A (November 2014). "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World J. Gastroenterol. 20 (42): 15616–23. doi:10.3748/wjg.v20.i42.15616. PMC 4229526. PMID 25400445.

Template:WikiDoc Sources

[pmid17573742-1] Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.

[2] Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034

[pmid8596552-3] Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.

[hhh-4] Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016

[nlm-5] Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016

[pmid27107781-6] Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.

[pmid8265100-7] Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994). "Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum". Oncology. 51 (1): 30–4. doi:10.1159/000227306. PMID 8265100.

[pmid27298573-8] Zhong ME, Niu BZ, Ji WY, Wu B (June 2016). "Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer". World J. Gastroenterol. 22 (22): 5293–6. doi:10.3748/wjg.v22.i22.5293. PMID 27298573.

[KopacovaTacheci20092-9] Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.

[GiardielloTrimbath2006-10] Giardiello, F; Trimbath, J (2006). "Peutz-Jeghers Syndrome and Management Recommendations". Clinical Gastroenterology and Hepatology. 4 (4): 408–415. doi:10.1016/j.cgh.2005.11.005. ISSN 1542-3565.

[BeggsLatchford2010-11] Beggs, A. D.; Latchford, A. R.; Vasen, H. F. A.; Moslein, G.; Alonso, A.; Aretz, S.; Bertario, L.; Blanco, I.; Bulow, S.; Burn, J.; Capella, G.; Colas, C.; Friedl, W.; Moller, P.; Hes, F. J.; Jarvinen, H.; Mecklin, J.-P.; Nagengast, F. M.; Parc, Y.; Phillips, R. K. S.; Hyer, W.; Ponz de Leon, M.; Renkonen-Sinisalo, L.; Sampson, J. R.; Stormorken, A.; Tejpar, S.; Thomas, H. J. W.; Wijnen, J. T.; Clark, S. K.; Hodgson, S. V. (2010). "Peutz-Jeghers syndrome: a systematic review and recommendations for management". Gut. 59 (7): 975–986. doi:10.1136/gut.2009.198499. ISSN 0017-5749.

[KopacovaTacheci20093-12] Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.

[pmid20011309-13] Chung TP, Hunt SR (May 2006). "Carcinoid and neuroendocrine tumors of the colon and rectum". Clin Colon Rectal Surg. 19 (2): 45–8. doi:10.1055/s-2006-942343. PMC 2780103. PMID 20011309.

[diagnostics-14] Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq

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@@ Line 49: / Line 49: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenocarcinoma]]<ref name="pmid8265100">{{cite journal |vauthors=Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C |title=Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum |journal=Oncology |volume=51 |issue=1 |pages=30–4 |date=1994 |pmid=8265100 |doi=10.1159/000227306 |url=}}</ref>
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Colorectal carcinoma ([[Adenocarcinoma]])<ref name="pmid8265100">{{cite journal |vauthors=Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C |title=Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum |journal=Oncology |volume=51 |issue=1 |pages=30–4 |date=1994 |pmid=8265100 |doi=10.1159/000227306 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |↑ or ↓
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 63: / Line 63: @@
 *[[Polyp|Polyps]] (villous, tubular, tubulo-villous)
 *[[Ulcer|Ulcerating polyps]]
-*[[cancerous]] [[lesions]]
+*[[Cancerous]] [[lesions]]
 | style="background: #F5F5F5; padding: 5px;" |
 *Luminal narrowing
-*[[bowel obstruction]]
+*[[Bowel obstruction]]
 *Thickening of the bowel wall
 *[[Lymphadenopathy]]
-*[[metastases]]
+*[[Metastases]]
 | style="background: #F5F5F5; padding: 5px;" |'''PET scans'''
 *[[Metastasis]]
@@ Line 75: / Line 75: @@
 *[[Cancer]] or [[Premalignant condition|precancerous]] [[polyp]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Different grades of differentiation of glandular structures
+* Different grades of differentiation of [[glandular]] structures
-** Sheets or cords of malignant cells,
+** Sheets or cords of [[malignant]] cells
-**Cellular [[atypia]], [[pleomorphism]]
+**[[Cellular]] [[atypia]] and [[pleomorphism]]
 **High [[Mitosis|mitotic]] rate
 * [[Necrosis|Necrotic]] debris in [[Glandular tissue|glandular lumina]]
 * [[Desmoplastic|Desmoplastic reaction (sign of invasion)]]
-| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]], genetic testing and [[histopathological]] analysis
+| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]], [[genetic testing]], and [[histopathological]] analysis
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Peutz-Jeghers syndrome]]<br><ref name="pmid27298573">{{cite journal |vauthors=Zhong ME, Niu BZ, Ji WY, Wu B |title=Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer |journal=World J. Gastroenterol. |volume=22 |issue=22 |pages=5293–6 |date=June 2016 |pmid=27298573 |doi=10.3748/wjg.v22.i22.5293 |url=}}</ref><ref name="KopacovaTacheci20092">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref><ref name="GiardielloTrimbath2006">{{cite journal|last1=Giardiello|first1=F|last2=Trimbath|first2=J|title=Peutz-Jeghers Syndrome and Management Recommendations|journal=Clinical Gastroenterology and Hepatology|volume=4|issue=4|year=2006|pages=408–415|issn=15423565|doi=10.1016/j.cgh.2005.11.005}}</ref><ref name="BeggsLatchford2010">{{cite journal|last1=Beggs|first1=A. D.|last2=Latchford|first2=A. R.|last3=Vasen|first3=H. F. A.|last4=Moslein|first4=G.|last5=Alonso|first5=A.|last6=Aretz|first6=S.|last7=Bertario|first7=L.|last8=Blanco|first8=I.|last9=Bulow|first9=S.|last10=Burn|first10=J.|last11=Capella|first11=G.|last12=Colas|first12=C.|last13=Friedl|first13=W.|last14=Moller|first14=P.|last15=Hes|first15=F. J.|last16=Jarvinen|first16=H.|last17=Mecklin|first17=J.-P.|last18=Nagengast|first18=F. M.|last19=Parc|first19=Y.|last20=Phillips|first20=R. K. S.|last21=Hyer|first21=W.|last22=Ponz de Leon|first22=M.|last23=Renkonen-Sinisalo|first23=L.|last24=Sampson|first24=J. R.|last25=Stormorken|first25=A.|last26=Tejpar|first26=S.|last27=Thomas|first27=H. J. W.|last28=Wijnen|first28=J. T.|last29=Clark|first29=S. K.|last30=Hodgson|first30=S. V.|title=Peutz-Jeghers syndrome: a systematic review and recommendations for management|journal=Gut|volume=59|issue=7|year=2010|pages=975–986|issn=0017-5749|doi=10.1136/gut.2009.198499}}</ref><ref name="KopacovaTacheci20093">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref>
@@ Line 96: / Line 96: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Hamartomatous intestinal polyposis|Multiple polyps]]
-* [[mucocutaneous]] [[pigmentation]]
+* [[Mucocutaneous]] [[pigmentation]]
 | style="background: #F5F5F5; padding: 5px;" |
 *[[Polyps|Multiple polyps]]
@@ Line 102: / Line 102: @@
 *[[Bowel obstruction]]
 | style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
-* Multiple [[Polyp|polyps]].
+* Multiple [[Polyp|polyps]]
 '''MRI'''
 * Multiple [[Hamartoma|hamartomatous]] [[Polyp|polyps]]
@@ Line 170: / Line 170: @@
 * ''[[SMAD4]]'' or ''[[BMPR1A]]''
 '''Diagnose if any of the following positive:'''
-* More than five juvenile [[Polyp|polyps]] of the [[colorectum]]
+* More than five juvenile [[Polyp|polyps]] of the colorectum
 * Multiple juvenile [[Polyp|polyps]] throughout the [[Gastrointestinal tract|GI tract]]
 * Any number of juvenile [[Polyp|polyps]] and a family history of juvenile [[polyposis]]
@@ Line 176: / Line 176: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Cyst|Cystic]] and dilated [[Crypt (anatomy)|crypts]] or [[Gland|glands]] with inspissated [[mucin]] and [[Lumen (anatomy)|intraluminal]] [[Neutrophil|neutrophils]]
-* [[Lamina propria]] [[Edema|edematous]] with associated [[Lymphocyte|lymphocytes]], [[Plasma cell|plasma cells]], [[Eosinophil granulocyte|eosinophils]] and [[Neutrophil|neutrophils]]
+* [[Lamina propria]] [[Edema|edematous]] with associated [[Lymphocyte|lymphocytes]], [[Plasma cell|plasma cells]], [[Eosinophil granulocyte|eosinophils]], and [[Neutrophil|neutrophils]]
 * [[Filiform papilla|Filiform]], multilobed forms with increased [[Glandular tissue|glandular]]-to-[[Stroma (animal tissue)|stroma]] ratio in nonclassic or [[Polyps|atypical polyps]]
 * Areas of conventional [[dysplasia]]
@@ Line 187: / Line 187: @@
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
-* [[asymptomatic]]
+* [[Asymptomatic]]
 * [[Satiety|Early satiety]]
 * [[Bloating]]
@@ Line 198: / Line 198: @@
 | style="background: #F5F5F5; padding: 5px;" |[[Benign]]
 * Small, < 10 cms
-* [[homogeneous]]
+* [[Homogeneous]]
 * Clear boundaries
 * [[intraluminal]] or extraluminal growth
@@ Line 221: / Line 221: @@
 * Multiple [[cysts]]
 | style="background: #F5F5F5; padding: 5px;" |
-*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles.<ref name="pmid12075401">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
+*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles<ref name="pmid12075401">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
 *[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular [[chromatin]] and appears nested
-*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and [[KIT|KIT protein.]]
+*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and KIT protein
 | style="background: #F5F5F5; padding: 5px;" |[[Endoscopic ultrasound]]
 [[biopsy]] and [[Histopathological|histopathological analysis]]
@@ Line 244: / Line 244: @@
 | style="background: #F5F5F5; padding: 5px;" |'''Biopsy'''
 * Proliferation of bland [[spindle cells]] in the [[lamina propria]]
-* mucosal [[Schwann cell tumor|Schwann cell hamartoma (]]MSCH))
+* Mucosal [[Schwann cell tumor|Schwann cell hamartoma]] (MSCH)
 | style="background: #F5F5F5; padding: 5px;" |
-* poorly circumscribed, short fascicles of uniform [[spindle cells]] replacing the [[Colon (anatomy)|colonic]] [[lamina propria]], separating and entrapping the [[Crypt (anatomy)|crypts]]
+* Poorly circumscribed, short fascicles of uniform [[spindle cells]] replacing the [[Colon (anatomy)|colonic]] [[lamina propria]], separating and entrapping the [[Crypt (anatomy)|crypts]]
 * The [[Cell nucleus|nuclei]] are bland and mostly uniform, occasional larger [[Cell nucleus|nuclei]] are found. The [[Cytoplasm|cytoplasmic]] borders are indistinct
 * Involvement of [[Mucous membrane|mucosa]] but never the [[submucosa]]
@@ Line 291: / Line 291: @@
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Nausea and vomiting|N/V]]
+* [[Nausea and vomiting]]
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 325: / Line 325: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * N/A
-| style="background: #F5F5F5; padding: 5px;" |N/A
+| style="background: #F5F5F5; padding: 5px;" |
+* N/A
 | style="background: #F5F5F5; padding: 5px;" |
 * Aberrant [[Blood vessel|vessels]] with thickened, hypertrophic walls in the [[Mucous membrane|mucosa]] and the [[submucosa]]
@@ Line 367: / Line 368: @@
 * Painful-hard lump in anus
 | style="background: #F5F5F5; padding: 5px;" | +
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |[[Anoscopy]]
-* [[Anoscopy]]: Protruding mass from the [[anus]]
+* Protruding mass from the [[anus]]
 | style="background: #F5F5F5; padding: 5px;" |
 * N/A
@@ Line 387: / Line 388: @@
 * [[Irritation]]
 | style="background: #F5F5F5; padding: 5px;" | +/-
+| style="background: #F5F5F5; padding: 5px;" |[[Anoscopy]]
+* Anal wall laceration
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Anoscopy]]: Anal wall laceration
+* N/A
 | style="background: #F5F5F5; padding: 5px;" |
 * N/A
-| style="background: #F5F5F5; padding: 5px;" |N/A
 | style="background: #F5F5F5; padding: 5px;" |
 * N/A
@@ Line 421: / Line 423: @@
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ulcerative colitis]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>V
 | style="background: #F5F5F5; padding: 5px;" |[[Diarrhea|↑]]
-| style="background: #F5F5F5; padding: 5px;" |<big>+</big>
+| style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" | +
@@ Line 438: / Line 440: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * N/A
-| style="background: #F5F5F5; padding: 5px;" |N/A
+| style="background: #F5F5F5; padding: 5px;" |
+* N/A
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Mucous membrane|Mucosal]] and [[Submucosa|submucosal]] [[inflammation]]
@@ Line 465: / Line 468: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * N/A
-| style="background: #F5F5F5; padding: 5px;" |N/A
+| style="background: #F5F5F5; padding: 5px;" |
+* N/A
 | style="background: #F5F5F5; padding: 5px;" |
 * Transmural pattern of [[inflammation]]
@@ Line 539: / Line 543: @@
 * Heaviness/dull discomfort in the groin, with straining, lifting, [[Cough|coughing]], or [[Physical exercise|exercising]]
 * [[Weakness]], heaviness, burning, or aching in the groin
-* [[swelling]]
+* [[Swelling]]
 * [[Fever]]

Colorectal cancer differential diagnosis: Difference between revisions

Revision as of 00:24, 27 January 2019

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Colorectal Cancer Differential Diagnosis

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