A 45-year-old woman was admitted to our hospital due to bilateral hydronephrosis with vomiting and back pain. On admission, hematological study showed normal CEA (2.9ng/ml) but, PET-CT revealed FDG uptake in the sigmoid colon. Barium enema and colonoscopy demonstrated segmental irregular narrowing of sigmoid loop with diffuse mural thickening showing cobblestone appearance. We attempted to do chemotherapy with FOLFOX4 for down staging. Nevertheless, we could not continue for 2 courses because of her death. Gross finding of the sigmoid colon showed typical cobblestone appearance with mural narrowing caused by submucosal as well as severe subserosal fibrosis due to lymphangitic carcinomatosa. The endoscopic images such as cobblestone appearance completely correlated with autopsy findings such as scirrhous infiltration of cancer cells and massive fibrosis.
