Case of a sigmoid colon cancer with metachronous metastases to the mesorectum and the abdominal wall
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Case of a sigmoid colon cancer with metachronous metastases to the mesorectum and the abdominal wall John Kalaitzis*, George Filippou, Adamantia Zizi-Sermpetzoglou, Athanasios Marinis, Andreas Hadjimarcou, Nikolaos Paschalidis, Spyros Rizos
Abstract Backround: Sigmoid colon cancer metachronous metastases commonly occur in the liver and lungs with sporadic reports also to the spleen, stomach, thyroid gland, abdominal wall and upper urinary tract. This is a rare case of metachronous metastases invading the mesorectum and the abdominal wall. Case presentation: A 72-year-old female underwent sigmoidectomy for stage I (T2N0 M0) sigmoid colon cancer in May 2008. In June 2009, an abdominal computed tomography scan revealed a tumor 2 cm in size at the lower anterior mesorectum and a second mass 2 cm in size at the anterior abdominal wall midline. Total colonoscopy showed no mucosal lesion. The serum carcinoembryonic antigen level was normal. A biopsy of the mesorectum tumor showed similar histologic characteristics with the primary tumor. Since no other site of recurrence was identified, an abdominoperineal resection was attempted. During the operation and after the removal of the incision recurrence, sinus bradycardia and signs of myocardial ischemia were noticed. A loop transverse colostomy was immediately perfomed and the operation was terminated. Postoperative cardiologic examination revealed an acute myocardium infract. Chemo-radiation of the mesorectum tumor and re-evaluation for surgical excision was decided. Conclusion: Metachronous metastasis of the mesorectum from sigmoid colon cancer is extremely rare. Although patterns of lymphatic spread from rectal cancer to sigmoid colon have recently been demonstrated, there is no evidence of metachronous mesorectum invasion from sigmoid colon cancer. This could be the issue for future trials.
Background Colon cancer as one of the most commonly diagnosed cancers around the world has an improved prognosis due to the development of diagnostic and therapeutic procedures. Overall survival however, can be seriously shortened, mostly in the presence of distant metastasis during follow-up. Liver is the commonest site of metachronous metastases in approximately one fourth of the patients, followed by the lungs [1]. Sporadic reports also demonstrate the spleen, thyroid gland, stomach, urinary system and abdominal wall as sites of possible reccurence [2-4]. This is a rare case of a sigmoid colon cancer
* Correspondence: [email protected] 1stDepartment of Surgery, General Hospital of Pireus Tzaneio, Athens, Greece
with metachronous metastases of the mesorectum and the abdominal wall.
Case Presentation A 72-year-old female was admitted to hospital suffering from fatigue, weight loss and rectal bleeding. Total colonoscopy demonstrated adenocarcinoma of the sigmoid colon at 25 cm from the anal verge. A chest x-ray was normal. No sites of distant metastasis were reported on abdominal computed tomography (CT) scan. The se
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