Abe Toshiya, Sakai Hiroshi, Hayashi Masataka, Nakamura So, Takesue Shin, Sada Masafumi, Kozono Shingo, Kitaura Yoshiki, Tanabe Yoshitaka, Nishihara Kazuyoshi, Mine Mari, Tamiya Sadafumi, Nakano Toru
Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, 802-0077, Japan.
Department of Pathology, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
Surg Case Rep. 2020 Apr 10;6(1):69. doi: 10.1186/s40792-020-00829-6.
Intramural metastasis is rare in colorectal cancer, especially metastasis of ascending colon cancer to the appendix.
A 64-year-old man was admitted to our hospital for surgery for ascending colon cancer detected by medical examination. Colonoscopy identified a type-2 tumor in the ascending colon, which was diagnosed as adenocarcinoma. Abdominal computed tomography revealed focal thickening of the ascending colon and middle of the appendix and swelling of the lymph nodes around the ileocolic artery. The patient underwent laparoscopic right hemi-colectomy with D3 lymph node dissection. Histopathological findings revealed that the ascending colon cancer was moderately differentiated adenocarcinoma with lymphatic and vascular invasion (stage IIIB; pT3N2M0). Additionally, moderately differentiated adenocarcinoma was observed mainly in the submucosa and muscularis propria of the appendix, which was approximately 10 cm proximal to the ascending colon cancer. These findings indicated intramural metastasis to the appendix from the ascending colon cancer. The patient experienced recurrence with lung metastasis 2.5 years after the first surgery.
Intramural metastasis of ascending colon cancer to the appendix is extremely rare. Because the risk of recurrence and the prognosis for intramural metastasis has not been clarified, careful follow-up is recommended.
结直肠癌壁内转移罕见，尤其是升结肠癌转移至阑尾。
一名64岁男性因体检发现升结肠癌入院接受手术。结肠镜检查发现升结肠有一个2型肿瘤，诊断为腺癌。腹部计算机断层扫描显示升结肠及阑尾中部局灶性增厚，回结肠动脉周围淋巴结肿大。患者接受了腹腔镜右半结肠切除术及D3淋巴结清扫术。组织病理学检查结果显示，升结肠癌为中度分化腺癌，伴有淋巴和血管侵犯（ⅢB期；pT3N2M0）。此外，在距升结肠癌近端约10 cm处的阑尾黏膜下层和固有肌层主要观察到中度分化腺癌。这些发现表明升结肠癌壁内转移至阑尾。患者在首次手术后2.5年出现肺转移复发。
升结肠癌壁内转移至阑尾极为罕见。由于壁内转移的复发风险和预后尚未明确，建议进行密切随访。
