ArticleFrontiers in oncology2025
Exophytic colonic carcinoma complicated by gastrocolic fistula mimicking a giant gastric mass: a case report and brief review.
Article in Frontiers in oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Colon cancer rarely presents as a giant exophytic mass that mimics a primary gastric malignancy. Such misleading features can result in diagnostic pitfalls and inappropriate surgical planning. We herein report a unique case of colonic adenocarcinoma involving the gastric wall and forming a gastrocolic fistula, initially misdiagnosed as gastric cancer. Moreover, we conducted a brief literature review on the diagnostic challenges associated with exophytic colonic carcinomas to enhance the understanding and management of this rare entity. A 60-year-old man presented with a one-month history of melena and fatigue. Initial abdominal CT and gastroscopy at a local hospital revealed a large exophytic mass occupying the gastric body, leading to a provisional diagnosis of gastric cancer. Biopsy suggested high-grade intraepithelial neoplasia with focal carcinoma. At our center, further evaluation including colonoscopy and PET/CT revealed a mass at the splenic flexure of the colon infiltrating the stomach wall. A multidisciplinary team discussion raised suspicion for colonic origin. The patient underwent en bloc resection including extended left hemicolectomy, partial gastrectomy, lymphadenectomy, distal pancreatectomy, splenectomy and postoperative HIPEC. Surgical findings confirmed a gastrocolic fistula. Final pathology revealed moderately-poorly differentiated adenocarcinoma of colonic origin invading the gastric wall. The patient recovered well postoperatively and completed six cycles of adjuvant chemotherapy, remaining recurrence-free at the 12-month follow-up. This case highlights a rare presentation of splenic flexure colon cancer mimicking a gastric tumor, underlining the importance of thorough preoperative evaluation, multidisciplinary discussion, and awareness of diagnostic traps in trans-organ gastrointestinal oncology.
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