An unusual cause of a huge abscess in the thigh

Article information

Korean J Intern Med. 2024;39(3):537-538

Publication date (electronic) : 2023 November 30

doi : https://doi.org/10.3904/kjim.2023.305

Dae Gon Ryu, Su Bum Park, Cheol Woong Choi, Su Jin Kim, Hyeong Seok Nam

Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Correspondence to: Su Bum Park, M.D., Ph.D. Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea, Tel: +82-55-360-2360, Fax: +82-55-360-1536, E-mail: psubumi@hanmail.net

Received 2023 July 20; Revised 2023 August 18; Accepted 2023 September 18.

A 91-year-old woman was transferred for the management of a huge abscess of the right thigh. The abscess was of approximately 30 cm craniocaudal sized in computed tomography (Fig. 1A). Since the patient was very old, percutaneous catheter drainage (PCD) was performed without further evaluation. After PCD, the abscess improved significantly (Fig. 1B), however, after 4 months, the patient was transferred again due to abscess aggravation. In computed tomography, a mass in the cecum was adjacent to the abscess (Fig 1C). Colonoscopy was performed without bowel preparation. A 3 cm sized mass with central opening in the cecum was observed (Fig. 2A). Because cecal cancer was considered the cause of abscess, right hemicolectomy with lymph node dissection was performed. Histological findings of the resected specimen showed adenocarcinoma with extracellular mucin production of approximately 40% (Fig. 2B). Thus, the patient was diagnosed with mucinous adenocarcinoma without lymph node metastasis (pT4bN0). Although she had surgery, cancer recurred and died two months after the surgery.

Figure 1

(A) On computed tomography (CT), intramuscular abscess was noted at right ilioposas, adductor, and vastus muscles. (B) After percutaneous catheter drainage, the abscess improved significantly. (C) Four months later, a huge abscess recurred and a mass (arrow) in the cecum was observed adjacent to the abscess on abdominal CT.

Figure 2

(A) A 3-cm sized mass with central opening in the cecum was observed on colonoscopy. (B) Histological findings of right hemicolectomy show adenocarcinoma with extracellular mucin production (H&E, × 50).

An abscess caused by colon cancer is mostly caused by perforation. Mucinous adenocarcinoma has high enzymatic activity, which can break the intestinal wall and infiltrate, resulting in the formation of an abscess. There have previously been cases of intraperitoneal or psoas muscle abscess caused by mucinous adenocarcinoma of the colon. We present a case of mucinous adenocarcinoma of the cecum manifested as a huge leg abscess with images.