Hachisuga Toru, Fujii Tsuyoshi, Araki Kenshiro, Kizaki Jynya, Mizuochi Shinji
Obstetrics and Gynecology/Gynecologic Oncology, Social Insurance Tagawa Hospital, Tagawa, JPN.
Surgical Gastroenterology, Social Insurance Tagawa Hospital, Tagawa, JPN.
Cureus. 2024 Dec 12;16(12):e75580. doi: 10.7759/cureus.75580. eCollection 2024 Dec.
A 67-year-old woman was diagnosed with ileocecal cancer presenting with intestinal obstruction. She underwent an ileocecal resection and D3 lymph node dissection. Pathological diagnosis showed a moderately differentiated adenocarcinoma, pT4aN0M0. Adjuvant chemotherapy using oxaliplatin and capecitabine was administered for six months. A CT scan one year after the initial operation revealed a myometrial nodule measuring 3 cm in diameter as a new lesion. We resected the myometrial nodule using laparoscopy, and no peritoneal metastases were observed. The intraoperative frozen section was suggestive of myometrial metastasis originating from colon cancer. Peritoneal washing cytology was negative for malignancy. Subsequently, a laparoscopic total hysterectomy and bilateral salpingo-oophorectomy were performed. The results of immunohistochemical stains were consistent with the patient's known colon cancer. The resected uterus, ovaries, and fallopian tubes were found to be free of metastatic colon cancer. We diagnosed the uterine lesion as an isolated myometrial metastasis from colon cancer and proceeded with surveillance without additional adjuvant treatment. She is alive and well one year after the second operation. When uterine metastasis from colon cancer is uncertain on cross-sectional imaging, laparoscopy is a useful tool for making an accurate diagnosis and exploring other intraperitoneal lesions.
一名67岁女性被诊断为回盲部癌并伴有肠梗阻。她接受了回盲部切除术和D3淋巴结清扫术。病理诊断显示为中分化腺癌，pT4aN0M0。使用奥沙利铂和卡培他滨进行了6个月的辅助化疗。初次手术后一年的CT扫描显示一个直径3厘米的子宫肌层结节为新病灶。我们通过腹腔镜切除了子宫肌层结节，未观察到腹膜转移。术中冰冻切片提示子宫肌层转移源自结肠癌。腹膜冲洗细胞学检查恶性结果为阴性。随后，进行了腹腔镜全子宫切除术和双侧输卵管卵巢切除术。免疫组化染色结果与患者已知的结肠癌一致。切除的子宫、卵巢和输卵管未发现转移性结肠癌。我们将子宫病变诊断为结肠癌孤立性子宫肌层转移，未进行额外辅助治疗，继续进行监测。第二次手术后一年，她状况良好，存活至今。当结肠癌的子宫转移在横断面成像上不确定时，腹腔镜检查是进行准确诊断和探查其他腹腔内病变的有用工具。
