Axillary lymph node metastasis from colorectal carcinoma is extremely rare, and this scarcity hinders understanding of its pathogenesis and, thus, the application of appropriate management. Here, we present a case with axillary lymph node metastasis of cecal carcinoma associated with macroscopic invasion of the skin of the abdominal wall with histological evidence of such invasion, findings which support our hypothesis that the axillary lymph node metastasis developed via the lymph channels in the skin of the abdominal wall. A 76-year-old woman with cecal carcinoma (T4N1M0), complicated with an abdominal wall abscess, underwent right hemicolectomy with partial resection of the abdominal wall. Histology demonstrated multiple sites of lymphatic invasion in the skin. Two months later, an enlarged right axillary lymph node was noticed on CT, and an excisional biopsy was obtained, which later confirmed metastatic adenocarcinoma. This is the first case report of axillary lymph node metastasis of carcinoma of the cecum with histologically proven invasion via the lymphatic system in the skin. If axillary lymph node metastasis results from aberrant lymphatics due to invasion from an adjacent organ, and not the result of systemic malignant disease, it may be considered as a surgically curable pathology. Therefore, the authors advocate that patients with axillary lymph node metastasis should be evaluated with regard to the possibility of surgical curability.
A 74-year-old woman with coronary artery disease had undergone coronary artery bypass grafting (CABG) with autologous vein grafts in 1999. She subsequently had recurrenct angina and underwent a second CABG in 2001 with the right gastroepiploic artery (GEA). The GEA pedicle was placed anterior to the stomach. In November 2004, the patient was admitted to the emergency room for back pain with nausea and vomiting. A repeat electrocardiogram did not show transient myocardial ischemia. A plain radiograph of the chest revealed the gas-filled dilatation of the stomach with fluid levels in the left base of the thorax. An upper gastrointestinal radiographic series using stomach tube revealed a strangulated intrapericardial gastric hernia. A computed tomographic scan with sagittal plane showed an intrapericardial hernia above the left lobe of the liver. Although herniation of the abdominal contents is a rare complication, it may be preventable. Techniques such as keeping the GEA pedicle small, minimizing the length of the diaphragmatic incision, placing interrupted sutures perpendicular to the musculotendinous fibers of the diaphragm, performing a gastropexy, and reinforcing the diaphragmatic incision with mesh may prevent this complication.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.