Unusual metachronous isolated inguinal lymph node metastasis from adenocarcinoma of the sigmoid colon
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Unusual metachronous isolated inguinal lymph node metastasis from adenocarcinoma of the sigmoid colon Adolfo Pisanu1*, Daniela Deplano1, Isabella Reccia1, Giuseppina Parodo2 and Alessandro Uccheddu1
Abstract This study aimed to describe an unusual case of metachronous isolated inguinal lymph nodes metastasis from sigmoid carcinoma. A 62-year-old man was referred to our department because of an obstructing sigmoid carcinoma. Colonoscopy showed the obstructing lesion at 30 cm from the anal verge and abdominal CT revealed a sigmoid lesion infiltrating the left lateral abdominal wall. The patient underwent a colonic resection extended to the abdominal wall. Histology showed an adenocarcinoma of the colon infiltrating the abdominal wall with iuxtacolic nodal involvement. Thirty three months after surgery abdominal CT and PET scan revealed a metastatic left inguinal lymph node involvement. The metastatic lymph node was found strictly adherent to the left iliacfemoral artery and encompassing the origin of the left inferior epigastric artery. Histology showed a metachronous nodal metastasis from colonic adenocarcinoma. Despite metastastic involvement of inguinal lymph node from rectal cancer is a rare but well known clinical entity, to the best of our knowledge, this is the first report of inguinal metastasis from a carcinoma of the left colon. Literature review shows only three other similar reported cases: two cases of inguinal metastasis secondary to adenocarcinoma of the cecum and one case of axillary metastasis from left colonic carcinoma. A metastatic pathway through superficial abdominal wall lymphatic vessels could be possible through the route along the left inferior epigastric artery. The solitary inguinal nodal involvement from rectal carcinoma could have a more favorable prognosis. In the case of nodal metastasis to the body surface lymph nodes from colonic carcinoma, following the small number of such cases reported in the literature, no definitive conclusions can be drawn. Keywords: sigmoid carcinoma, inguinal lymph node, unusual metastasis, metachronous metastasis
Background Inguinal lymph nodes metastasis from colorectal adenocarcinoma is considered as an uncommon clinical occurrence [1]. We report the case of a metachronous isolated inguinal lymph node metastasis from an adenocarcinoma of the sigmoid colon. To the best of our knowledge, this is the first report of inguinal metastasis arising from a carcinoma of the left colon. Case presentation In December 2007, a 62-year-old Caucasian man was referred to our surgical department because of an * Correspondence: [email protected] 1 Department of Surgery, Clinica Chirurgica, University of Cagliari, Cagliari, Italy Full list of author information is available at the end of the article
obstructing sigmoid carcinoma. Otherwise, his previous medical history was unremarkable. On examination the abdomen was soft, but distended. Laboratory data on admission were as follows: white blood cell count 82
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