Colon carcinoma metastases with extension to chest wall and pericardium

Document Type: Case Report

Authors

Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Management of locally advanced colon cancer metastases is challenging and operation carries an increased risk of morbidity and mortality. The knowledge of exact sites of involvement can aid the surgeon to make a decision regarding complete resection or palliative therapy. PET/CT scan is an advantage in this setting because metabolic alterations often precede the anatomic changes; moreover, it can show unexpected metastases. In addition, PET/CT scan can differentiate adhesions and scar from local invasion of tumor.  We report a rare case of locally advanced colon cancer metastases to mesentery with extension to liver, chest wall and mediastinum depicted on PET/CT scan. The patient was treated with resection of the involved sites. The pathology report confirmed a poorly differentiated adenocarcinoma mainly involving the mesentery with extension to surrounding organs including the liver. Unfortunately, the patient’s condition deteriorated following surgical intervention. Although there is a trend toward complete resection of primary tumor and involved sites in patients with metastatic colon carcinoma to improve overall patient survival by eliminating any residual disease, in more advanced stages of the disease, palliative therapy might be the preferred approach. PET/CT has invaluable complimentary role to improve surgical planning in advanced oncological situations.

Keywords

Main Subjects


  1. Schumacher A, Babikir OM, Abboud A, Theodorakis S. A rare presentation of locally re-recurrent colon cancer involving the iliac bone and a review of the literature. BMJ Case Rep. 2014 Oct 29;2014. pii: bcr2014203547.
  2. Sadahiro S, Suzuki T, Ishikawa K, Nakamura T, Tanaka Y, Masuda T, Mukoyama S, Yasuda S, Tajima T, Makuuchi H, Murayama C. Recurrence patterns after curative resection of colorectal cancer in patients followed for a minimum of ten years. Hepatogastroenterology. 2003 Sep-Oct;50(53):1362-6.
  3. Lo DS, Pollett A, Siu LL, Gallinger S, Burkes RL. Prognostic significance of mesenteric tumor nodules in patients with stage III colorectal cancer. Cancer. 2008 Jan 1;112(1):50-4.
  4. Nesseris I, Tsamakis C, Gregoriou S, Ditsos I, Christofidou E, Rigopoulos D. Cutaneous metastasis of colon adenocarcinoma: case report and review of the literature. An Bras Dermatol. 2013 Nov-Dec;88(6 Suppl 1):56-8.
  5. Brazão SG, Silva D, Duarte J, Correia JB, Verissimo MT, Carvalho A. Superior Vena Cava Syndrome: An Uncommon Presentation of a Rare Colon Carcinoma Metastasis. Eur J Case Rep Intern Med. 2019 May 15;6(5):001115.
  6. März L, Piso P. Treatment of peritoneal metastases from colorectal cancer. Gastroenterol Rep (Oxf). 2015 Nov;3(4):298-302.
  7. Tenreiro N, Ferreira C, Silva S, Marques R, Ribeiro A, Sousa PJ, Luís FP. Locally advanced colon cancer with cutaneous invasion: case report. BMC Res Notes. 2017 Mar 1;10(1):113.
  8. Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics. 2001 Mar-Apr;21(2):439-49.
  9. Loutfy A, Vasani S. Locally advanced colon cancer resulting in en bloc right hemicolectomy and pancreaticoduodenectomy: case report and review of literature. J Surg Case Rep. 2018 May 18;2018(5):rjy100.
  10. Cirocchi R, Partelli S, Castellani E, Renzi C, Parisi A, Noya G, Falconi M. Right hemicolectomy plus pancreaticoduodenectomy vs partial duodenectomy in treatment of locally advanced right colon cancer invading pancreas and/or only duodenum. Surg Oncol. 2014 Jun;23(2):92-8.
  11. Tevis SE, Kennedy GD. Postoperative complications: looking forward to a safer future. Clin Colon Rectal Surg. 2016 Sep;29(3):246-52.
  12. Landmann RG, Weiser MR. Surgical management of locally advanced and locally recurrent colon cancer. Clin Colon Rectal Surg. 2005 Aug;18(3):182-9.
  13. Lin EC, Alavi A. PET and PET/CT: a clinical guide. 3rd ed: Thieme; 2019.
  14. Delbeke D, Martin WH. FDG PET and PET/CT for colorectal cancer.  Positron Emission Tomography: Springer; 2011. p. 77-103.