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

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Title: Solitary left axillary lymph node metastasis after curative resection of carcinoma at the colostomy site : a case report
Authors: Imaizumi, Ken Browse this author
Homma, Shigenori Browse this author →KAKEN DB
Yoshida, Tadashi Browse this author
Shimokuni, Tatsushi Browse this author
Sakihama, Hideyasu Browse this author →KAKEN DB
Takahashi, Norihiko Browse this author
Kawamura, Hideki Browse this author
Takakuwa, Emi Browse this author
Taketomi, Akinobu Browse this author →KAKEN DB
Keywords: Colon cancer
Axillary lymph node metastasis
Colostomy site
Pagetoid spread
Adjuvant chemotherapy
Issue Date: 21-Sep-2016
Publisher: Springer
Journal Title: Surgical case reports
Volume: 2
Start Page: 99
Publisher DOI: 10.1186/s40792-016-0229-3
Abstract: Background: The 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 presentation: A 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 F-18-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. Conclusions: The 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.
Type: article
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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