Colon cancer is a leading cause of cancer mortality. It could be asymptomatic but usually presents with bowel movement changes and anemia. We present a case of colonic adenocarcinoma that presented with Plummer-Vinson syndrome.
A 66-year-old woman presented with a 3-month history of dysphagia. She had progressive dysphagia to solid foods that led to a 10-pound weight loss. She also had dyspnea, malaise, and fatigue. She denied any anorexia, nausea, abdominal pain, constipation, diarrhea, melena, or hematochezia. She never had any age-appropriate cancer screening. She had no family history of malignancy.
On presentation, she was ill appearing with a pale conjunctiva and glossitis (Figure 1). The abdomen was flat, soft, and nontender. There was no hepatosplenomegaly. Rectal examination did not reveal any mass. Fecal occult blood was negative.
The patient’s hemoglobin was 1.6 g/dL. The iron studies and peripheral blood smear were consistent with iron deficiency anemia. The smear showed normal white blood cells (5.7 × 103) and adequate platelets (204 × 103). Bone marrow biopsy showed normal marrow with absent iron stores.
Esophagogastroduodenoscopy revealed a postcricoid esophageal web (Figure 2). The patient had dilatation of the web. Colonoscopy showed a hard, friable circumferential mass in the ascending colon (Figure 3). Biopsy revealed invasive adenocarcinoma. Computed tomography of the abdomen and pelvis showed a 6-cm mass in the proximal transverse colon with contiguous mesenteric lymphadenopathy. She underwent neoadjuvant chemotherapy and subsequent colonic resection. Iron supplementation was initiated.
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-Nellowe Candelario, MD, Andrew Tiu, MD
This article originally appeared in the November issue of The American Journal of Medicine.
