Solitary left axillary lymph node metastasis after curative resection of carcinoma at the colostomy site: a case report

Abstract

BackgroundThe incidence of axillary lymph node metastasis (ALNM) of colon cancer is very low, and there have been only a few reports of solitary ALNM. Neither the mechanism involved in solitary colon cancer ALNM nor the proper treatment has been elucidated. We encountered a case of solitary left ALNM after curative resection of carcinoma at the colostomy site.Case presentationA 53-year-old man underwent a Hartmann’s operation for Hirschsprung disease during his adolescence. He complained of a mass of the descending colon and was diagnosed with colon cancer at the colostomy site with pagetoid spread to the adjacent skin. The cancer at the stoma site was resected, and a transverse colostomy was performed. Nine years later, his carbohydrate antigen (CA) 19-9 level was high during a health screening. On physical examination, adenopathy was palpated in the left axilla. Computed tomography (CT) demonstrated a lymph node in the left axillary fossa that was 33 mm in diameter, and 18F-fluorodeoxyglucose positron emission tomography/CT showed high uptake in the lesion. We performed a curative resection of the left axillary lymph node. The lesion was pathologically diagnosed as left ALNM originating from the adenocarcinoma at the colostomy site. After lymph node resection, his serum CA19-9 level decreased compared to that observed at baseline. He has been receiving adjuvant chemotherapy (capecitabine plus oxaliplatin) without recurrence for 5 months after lymph node resection.ConclusionsThe present case report shows that carcinoma at the colostomy site with pagetoid spread can metastasize to the axillary lymph nodes through superficial abdominal lymphatic pathways, and surgical resection followed by adjuvant chemotherapy may be a potent strategy to treat solitary colon cancer ALNM.

Surgical treatment of massive stoma site tumors after a curative operation for rectal cancer

“…Given the low incidence of stoma site tumors, the management protocol is unknown. Indeed, no previous studies have examined the need to add chemotherapy pre-or post-operatively, although adjuvant chemotherapy is recommended in some case reports [7,12,13,15]. In our group, postoperative adjuvant chemotherapy was recommended for all patients, but compliance was not high.…”

Destination Unknown: A Unique Case of Metastatic Colorectal Carcinoma to the Breast, Axilla & Skin

“…However, Kawamura et al demonstrated that the superficial system may be more pertinent in the evolution of axillary lymph node involvement as the abdominal wall superior to the umbilicus drains upwards into the axillary nodes [13]. Unlike published reports of involvement of the left breast in 55% of cases, this patient's metastatic lesion occurred on the right breast, but similar to documented cases, her breast lesion was superficial, located in the upper outer quadrant, was mobile and fell within the reported size range (between 1 and 10 cm) [3] [12].…”

“…However, individual case reports suggest that some patients may potentially achieve long-term survival. A case report by Imaizumi et al documented a nine-year survival between the time of initial diagnosis of colon cancer and axillary lymph node recurrence, suggesting that tumour biology may influence the metastatic potential in such cases [13]. Traditionally, the treatment of metastatic disease is based on the pathogenesis and biology of the primary tumour.…”

Axillary Lymph Node Metastasis as the First Symptom of Colon Cancer

“…This route is typically seen in cases of colon cancer with abdominal wall invasion. [4][5][6][7] Moreover, colon cancer may metastasize to the breast before spreading to the axillary lymph node. 8 Concurrent metastasis to the right axillary lymph nodes in ascending colon cancer has not been reported previously.…”

“…Another possible pathway for axillary lymph node metastasis is through the superficial abdominal lymphatics, which establish lymphatic drainage channels between the abdominal wall and the thoracic wall, allowing colon cancer to reach the axillae bilaterally. This route is typically seen in cases of colon cancer with abdominal wall invasion 4–7 . Moreover, colon cancer may metastasize to the breast before spreading to the axillary lymph node 8 .…”