Madhuri Badrinath, MBBS1, Ajay Tambe, MBBS1, Umair Masood, MD2, Divey Manocha, MD2
1SUNY Upstate Medical Center, Syracuse, NY; 2SUNY Upstate Medical University, Syracuse, NY
Introduction: Colorectal cancer(CRC) with direct abdominal wall and skin invasion is an extremely rare finding. We present a unique case of CRC with an oligometastatic lesion in the abdominal wall.
Case Description/Methods: Patient is a 56 year old male who presented to the gastroenterology clinic with 2 months of constipation and hematochezia, in the absence of melena,weight loss, anorexia and abdominal pain. A screening colonoscopy revealed severe stenosis in the descending colon(50 cm proximal to the anus) with inability to further advance the scope. This area was biopsied and tattooed; pathological diagnosis was confirmed to be moderately differentiated adenocarcinoma.Tumor markers were negative and CT of the abdomen/pelvis was done which showed lymphadenopathy around the descending colon with no evidence of metastasis. 2 weeks later he underwent a robotic-assisted left colon resection with intracorporeal anastomosis, with no immediate postoperative complications.The histopathology of the resected mass was consistent with the initial biopsy findings and lymph nodes were negative for malignancy. Patient underwent adjuvant chemotherapy with capecitabine and oxaliplatin for 4 cycles which was well tolerated.A year later he developed a slowly progressive asymptomatic mass in the right abdominal wall.CT of the abdomen revealed a focal soft tissue mass measuring 3x3cm, involving the right lower anterolateral abdominal wall and rectus abdominis muscle.CT guided biopsy revealed metastatic adenocarcinoma consistent with primary CRC. PET scan was devoid of any metastatic or recurrent disease in other locations. Hence proceeded with resection of the mass and mesh placement for the abdominal wall defect. Patient tolerated the procedure well. The follow up scans have shown no evidence of recurrence or metastatic disease, and patient is symptom free
Discussion: CRC often metastasizes to regional lymph nodes,liver, lung or bone via lymphatic and hematogenous routes. Abdominal wall metastasis is very rare and can be caused by direct invasion, lymphatic or hematogenous routes, and direct cancer cell implantation during prior surgical intervention which is the probable source in our patient. Laparoscopic resection is a feasible treatment option for solitary abdominal wall metastasis along with the advantage of assessing the abdomen for other metastases; especially in patients with advanced CRC who are at higher risk of developing fatal complications like peritoneal dissemination that may affect management.
Citation: Madhuri Badrinath, MBBS; Ajay Tambe, MBBS; Umair Masood, MD; Divey Manocha, MD. P1970 - RARE CASE OF ABDOMINAL WALL METASTASIS SECONDARY TO COLON CANCER. Program No. P1970. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.