Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report

Abstract

BackgroundCarcinomas occurring at colostomy sites are rare, and most of these are metachronous colorectal cancers. The median time between colostomy and development of a carcinoma at a colostomy site is 22 years, which exceeds the length of the recommended follow-up period. We report a rare case of a carcinoma of the transverse colon occurring at a colostomy site in a patient without a history of colorectal cancer.Case reportAn 89-year-old woman presented with a tumor occurring at a colostomy site. Thirty-five years previously, she had undergone a transverse loop colostomy for an iatrogenic colon perforation that occurred during left ureteral lithotomy. Upon physical examination, the patient had a hard nodule measuring 3 cm at the colostomy site. A biopsy of the nodule suggested adenocarcinoma, and the preoperative diagnosis was transverse colon cancer. A laparotomy was performed via a peristomal incision with 5-mm skin margins, and the tumor was covered by a surgical glove to avoid any tumor seeding. The colon was separated from the tumor by 5-cm margins, and the specimen was removed en bloc. An end colostomy was constructed to a new site on the right side of the abdomen. The deficit in the abdominal wall was repaired, and the skin was closed via a purse-string suture. The final diagnosis of the stoma tumor was transverse colon cancer (T2, N0, M0, stage I). One year and five months after surgery, there was no evidence of recurrence.ConclusionsThe occurrence of carcinomas at colostomy sites in patients without a history of colorectal cancer is rare. It is important to train ostomates to monitor the stoma for possible tumor recurrence.

Metachronous Adenocarcinoma at Stoma Site 50 Years After Abdominoperineal Resection for Carcinoma Rectum:a Case Report and Review of Literature

“…Speci cally, the incidence of metachronous colorectal cancer after abdominoperineal resection for rectal cancer is around 2.2% [5]. Very rarely, such tumors may appear at the stomal site post-surgery for a malignant condition but have also been described in patients with stomas for non-malignant conditions, such as sigmoid volvulus and iatrogenic perforations [7]. In our case, the patient came with late metachronous adenocarcinoma at the colostomy site after 50 years.…”

“…Towney et al and Takeuchi et al brie y discussed the genetic susceptibility of metachronous stoma site cancer in view of multiple malignancies [13,14]. Around 51% of metachronous tumors are located in the left hemi colon, hence the high chance of malignancy in the left side colon stoma after surgical management for colorectal malignancy [7].…”

Metachronous carcinoma at the colostomy site after abdominoperineal resection of rectal cancer: a case report

“…Although most colorectal metastases occur within 2 years from the primary tumor resection, the occurrence of metachronous carcinoma at the stoma site varies from 4 to 30 years after the initial resection of the primary tumor [ 2 ]. Clinical manifestation of carcinoma at the stoma site include tumor in 7 cases, bleeding and stoma stenosis in 2 cases each, and ulceration in 1 case [ 4 ].…”

Intestinal Stomas—Postoperative Stoma Care and Peristomal Skin Complications

“…Stomal malignancy has rarely been described in case reports. 38 Stomal malignancy may arise as metachronous colorectal cancer, sequela of inflammatory bowel disease, or spontaneous de novo cancer, or can represent locoregional spread from cutaneous malignancy. Stomal metastasis arising from other carcinomas including colorectal, gastric, and lung neoplasms have been reported.…”