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Nomura M, Tei M, Goto T, Hirano M, Nishida K, Mori S, Yoshikawa Y, Tamai K, Hamakawa T, Takiuchi D, Tsujie M, Akamaru Y. Rare recurrence pattern after complete response to chemotherapy in a patient with rectal cancer: a case report. Surg Case Rep 2024; 10:114. [PMID: 38714637 PMCID: PMC11076440 DOI: 10.1186/s40792-024-01913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/26/2024] [Indexed: 05/10/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) often metastasizes to the liver, lungs, lymph nodes, and peritoneum but rarely to the bladder, small intestine, and skin. We here report the rare metastasis of anal cancer in the left bladder wall, followed by metastases to the small intestine and skin, after abdominoperineal resection and left lateral lymph node dissection with chemotherapy in a patient with clinician Stage IVa disease. CASE PRESENTATION A 66-year-old man presented with 1-month history of bloody stool and anal pain and diagnosed with clinical Stage IVa anal cancer with lymph node and liver metastases (cT3, N3 [#263L], M1a [H1]). Systemic chemotherapy led to clinical complete response (CR) for the liver metastasis and clinical near-CR for the primary tumor. Robot-assisted laparoscopic perineal rectal resection and left-sided lymph node dissection were performed. Computed tomography during 18-month postoperative follow-up identified a mass in the left bladder wall, which was biopsied with transurethral resection, was confirmed as recurrent anal cancer by histopathologic evaluation. After two cycles of systemic chemotherapy, partial resection of the small intestine was performed due to bowel obstruction not responding to conservative therapy. The histopathologic evaluation revealed lymphogenous invasion of the muscularis mucosa and subserosa of all sections. Ten months after the first surgery for bowel obstruction and two months before another surgery for obstruction of the small intestine, skin nodules extending from the lower abdomen to the thighs were observed. The histopathologic evaluation of the skin biopsy specimen collected at the time of surgery for small bowel obstructions led to the diagnosis of skin metastasis of anal cancer. Although panitumumab was administered after surgery, the patient died seven months after the diagnosis of skin metastasis. CONCLUSIONS This case illustrates the rare presentation of clinical Stage IVa anal cancer metastasizing to the bladder wall, small intestine, and skin several years after CR to chemotherapy.
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Affiliation(s)
- Masatoshi Nomura
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan.
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Takayoshi Goto
- Department of Pathology, Osaka Rosai Hospital, Sakai, Osaka, 591-8025, Japan
| | - Masataka Hirano
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Kentaro Nishida
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Soichiro Mori
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Yukihiro Yoshikawa
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Koki Tamai
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Takuya Hamakawa
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Daisuke Takiuchi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Masanori Tsujie
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Yusuke Akamaru
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Nagasone 1179-3, Kita Ward, Sakai, Osaka, 591-8025, Japan
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Albandak M, Albandak M, Abdallah J, Qawasmeh M. Cutaneous Limb Metastasis of Colorectal Cancer Misdiagnosed as Zoster Infection. Cureus 2023; 15:e36621. [PMID: 37155449 PMCID: PMC10122784 DOI: 10.7759/cureus.36621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/10/2023] Open
Abstract
Cutaneous metastasis is a rare manifestation of internal malignancies. It usually occurs with the later progression of the disease and is associated with a poor prognosis. Common culprits of skin metastasis include lung cancer, melanoma, and colorectal cancer in men and breast cancer, colorectal cancer, and melanoma in women. Given these points, there is a low rate of cutaneous metastasis of colorectal cancer. When present, the most common sites include the abdominal wall and, less frequently, the face and the scalp. Rarely there is cutaneous metastasis to the upper extremity. Herein, we report the case of a female patient in her 50s who presented with a maculopapular rash of the right upper limb four years after her initial diagnosis of colonic adenocarcinoma. However, because of this rare manifestation, she was initially misdiagnosed with more common causes of a maculopapular rash. After a period of no improvement with preliminary treatment, a biopsy with immunohistochemical staining was undertaken, and the specimen stained positive for CK20 and CDX2, confirming metastatic colorectal malignancy. Skin lesions that are not responding to conventional therapy and those which have bizarre presentations can be a harbinger of internal malignancy and should be considered in the differential.
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Affiliation(s)
| | - Miral Albandak
- Pharmacy, Birzeit University Faculty of Pharmacy Nursing and Health Professions, Birzeit, PSE
| | | | - Mohammed Qawasmeh
- Pharmacy, Birzeit University Faculty of Pharmacy Nursing and Health Professions, Birzeit, PSE
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