84 Ulcerative Mass in the Cecum and Proximal Ascending Colon Mimicking Colon Cancer in a Patient with Long-term Nonsteroidal Anti-inflammatory Drug (NSAID) Use: An Extremely Rare Case Report

Introduction/Objective The formation of a mass in the colon due to nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers is extremely rare. Methods/Case Report A 63-year-old male with a history of coronary artery disease, status post coronary artery bypass grafting more than 25 years ago, and daily aspirin use (81 mg), presented with a 4-day history of hematochezia without weight loss. Esophagogastroduodenoscopy revealed no bleeding source, but colonoscopy identified an ulcerated, non-obstructive mass in the cecum and proximal ascending colon. A biopsy revealed colonic mucosa with severe ulceration and granulation tissue. The subsequent right hemicolectomy specimen revealed a 5.5 cm ill-defined ulcerative mass in the cecum and ascending colon. Microscopically, the cecum and ascending colon showed ulcerated mucosa with fibrosis, reactive changes, and foreign body material deposition, without evidence of malignancy. Immunohistochemical stains for cytomegalovirus and herpes simplex virus were negative. Based on the clinical history, medication usage, and histologic features, the findings are consistent with NSAID-induced ulceration of the colon, which mimics a malignant mass in the cecum and ascending colon. Results NA Conclusion This report describes a case of an ulcerative mass in the cecum and ascending colon, mimicking malignancy in a patient with long-term NSAID use. Awareness of this entity is crucial for making an accurate diagnosis.