Abstract
Lymph node metastasis to the iliac or inguinal region of colon cancer is extremely rare. We experienced a case of ascending colon cancer with synchronous isolated right external iliac and inguinal lymph node metastases but without any regional lymph node metastasis. An 83-year-old woman was admitted to our hospital due to anemia. Colonoscopy and computed tomography revealed an ascending colon cancer and also right external iliac and inguinal lymph node swelling. Further examination by F-deoxyglucose positron emission tomography strongly suggested that these lymph nodes were metastatic. Right hemicolectomy with lymph node dissection along the superior mesenteric artery, and right external iliac and inguinal lymph node dissection were performed. Histological examination revealed that both lymph nodes were metastasized from colon cancer, and there was no evidence of regional lymph node metastasis. The patient has shown no sign of recurrence at 27 months after surgery.
Highlights
Distant metastasis of cancer is considered to be a systematic disease, and curative surgical treatment is not generally applied
We describe an extremely rare case of ascending colon cancer with synchronous isolated right external iliac and inguinal lymph node metastases with neither regional lymph node metastasis nor distant hematogenous metastasis, for whom a potentially curative operation which included distant metastatic lymph node dissection was performed
A right hemicolectomy with lymph node dissection along the superior mesenteric artery, and right external iliac and inguinal lymph node dissection were performed (Fig. 3a, b), and we confirmed the metastasis of adenocarcinoma in these distant lymph nodes through the intraoperative histological examination
Summary
Distant metastasis of cancer is considered to be a systematic disease, and curative surgical treatment is not generally applied. We describe an extremely rare case of ascending colon cancer with synchronous isolated right external iliac and inguinal lymph node metastases with neither regional lymph node metastasis nor distant hematogenous metastasis, for whom a potentially curative operation which included distant metastatic lymph node dissection was performed. A right hemicolectomy with lymph node dissection along the superior mesenteric artery, and right external iliac and inguinal lymph node dissection were performed (Fig. 3a, b), and we confirmed the metastasis of adenocarcinoma in these distant lymph nodes through the intraoperative histological examination. As for the external iliac and inguinal lymph nodes, both of them were well-differentiated adenocarcinoma and revealed to be metastasis from the colon cancer by immunohistochemical examination, which revealed a profile that cytokeratin 7 was negative and cytokeratin 20 and caudal-related homeobox 2 (CDX2) were positive (Fig. 4) [8]. The woman has had no recurrence at 27 months since the operation
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