Extensive Calcified Retroperitoneal Lymph Node Metastases from a Primary Carcinoma of the Cecum

Abstract

Calcifications of carcinomas of the gastrointestinal tract or their metastases are uncommon but have been well documented in several small series. With the exception of calcified hepatic metastases, however, only two reports (1, 2) could be found of calcined metastases from a primary carcinoma of the colon (excluding that of the rectum). In neither of these were there distant retroperitoneal calcified metastatic lymph nodes as in the case reported below. A 62-year-old white male was admitted on July 18, 1966, with complaints of a 60-1b. loss of weight over the past nine months and generalized weakness. At the time of a right colectomy in April 1964, extensive metastases were found in the abdomen. The pathologist reported ulcerated and infiltrating adenocarcinoma Grade III of the cecum and ascending colon. Thereafter, the patient had done well clinically, although liver metastases were suspected in December 1964. In September 1965 a chest film showed bilateral pulmonary metastases. Roentgen examination of the abdomen on July 18, 1966, demonstrated bilateral stippled calcifications, 1–2 mm in diameter, in the retroperitoneal space. These were considered to be calcified metastatic lymph nodes. In retrospect they could be seen on films of the lumbar spine taken in December 1965, and no significant change was noted over the following seven and a half month period, although osteoblastic metastatic involvement of the body of L4 developed in the interim. During the entire course of his illness, the patient received only symptomatic therapy; no chemotherapy or irradiation was given. The patient died on July 28, 1966. At autopsy, multiple metastases were encountered in the liver, the peritoneal cavity, and the retroperitoneal space, and extensive deposits were seen in the pleural space, the mediastinum, and the lung. Roentgenograms of the sectioned liver showed no calcifications in the liver metastases which could not be identified radiographically. The calcified lymph nodes seen on the films proved at autopsy to be the retroperitoneal nodes. The stippled calcifications were apparent macroscopically as gritty, chalky deposits. Microscopic sections showed metastatic carcinoma containing partially calcified caseous material representing the stippled calcifications seen on the film. Discussion Why calcium is deposited in certain benign and malignant neoplasms is not clearly understood. It appears that the calcium deposition is usually the result of a degenerative process developing in areas of hemorrhage and necrosis such as those seen in the photomicrograph of this patient. Summary An unusual case of calcified retroperitoneal lymph node metastases from a primary carcinoma of the colon is described which is believed to be the first of its kind. The correct diagnosis was made from survey films of the abdomen.