Colon cancer metastasis to mediastinal lymph nodes without liver or lung involvement: A case report

Abstract

Colon cancer is the second most common type of cancer in females and the third in males, worldwide. The most common sites of colon cancer metastasis are the regional lymph nodes, liver, lung, bone and brain. In this study, an extremely rare case of colon adenocarcinoma with extensive metastasis to the mediastinal lymph nodes without any other organ involvement is presented. A 44-year-old Caucasian male presented with abdominal pain, a change in bowel habits, melena and weight loss. Colonoscopy revealed a large friable, ulcerated, circumferential mass in the ascending colon. Biopsies were consistent with the diagnosis of invasive moderately differentiated adenocarcinoma. Subsequently, right colon resection was performed, and pathological analysis revealed moderately differentiated adenocarcinoma of the right colon with extensive regional lymph node involvement. Computed tomography (CT) scans of the chest, abdomen and pelvis were performed preoperatively as part of routine staging for colon cancer. No liver or lung pathology was identified; however, multiple pathologically enlarged mediastinal lymph nodes were observed. Endoscopic ultrasound with fine needle aspiration of the largest mediastinal lymph node, which measured 5.2×3.5 cm on CT scans, was performed. The pathology was again consistent with the diagnosis of metastatic colorectal primary adenocarcinoma. At present, no optimum treatment has been identified for metastatic colon cancer to the mediastinal lymph nodes. The patient in the current case received chemotherapy with folinic acid, fluorouracil and oxaliplatin (FOLFOX), as well as with bevacizumab. Initial follow-up CT scans of the chest revealed a positive response to treatment. Physicians, in particular, radiologists, must consider the mediastinum during the first evaluation and further follow-up of patients with colorectal carcinoma even in the absence of metastasis.

<p>Virchow&rsquo;s node: a case report of an extremely rare presentation of metastasis of adenocarcinoma with mucinous features from the colon</p>

“…Typically, the most common sites of colon cancer metastasis are regional lymph nodes, liver, lung, bone and brain, with ours demonstrating an extremely rare pattern of colon cancer metastasis. 4 The novelty of this case revealed metastatic involvement to the left supraclavicular node without end organ involvement, ie (liver, lungs) conjugated with the patients carcinomic history.…”

“…2 Mucinous carcinoma is defined according to WHO as a subtype of colorectal carcinoma (CRC) with mucin lakes comprising at least 50% of the tumor mass. 3 Distal nodal metastatic colon cancer is uncommon and metastasis of CRC to the left supraclavicular lymph node, also known as Virchow’s node, is extremely rare without signs and symptoms of metastatic organ involvement 4,5…”

Mediastinal Mass in a Patient with Colorectal Cancer: A Diagnostic Challenge

“…In both cases, CT scan revealed pathological mediastinal adenopathies. In the case reDuplication Esophageal Cyst ported by El-Halabi et al [1] , the definitive diagnosis was made by EUS-guided FNA, which revealed multiple, enlarged, rounded, homogeneous, and hypoechogenic subcarinal lymph nodes. Musallam et al [2] presented a patient with solitary enlarged right paratracheal lymph node, positive on fluor-18-deoxyglucose positron emission tomography scan, who underwent mediastinoscopic biopsy, which revealed metastatic adenocarcinoma.…”

“…There are a few reports of solitary metastatic mediastinal lymph node of colorectal cancer (CRC) without any other organ involvement [1,2] . Posterior mediastinal cystic lesions represent 15-20% of all primary posterior mediastinal masses and include bronchogenic, pericardial, neuroenteric, and duplication esophageal cysts (DEC) [3] .…”

<p>Sorcin: a novel potential target in therapies of cancers</p>

“…However, in recent years, we find that MDR seems to be related to sorcin. Sorcin is a calcium-binding protein that is highly expressed and induces MDR in several cancer patients 15,16. Sorcin affects the functions of P-gp by the regulation of cellular calcium levels and the phosphorylation of P-gp.…”