2017 Volume 42 Issue 2 Pages 219-225
Intramural metastases are not common in colorectal cancer. Most of them are simultaneous, and there are few reports of metachronous intramural metastases. We report a rare case of multiple intramural metastases in the rectum of the descending colon cancer.
A 72-year old man underwent a left hemicolectomy for descending colon cancer. Pathological examination revealed a moderately differentiated adenocarcinoma with vascular invasion. Nineteen-months after the operation, follow up colonoscopy was performed. Two submucosal tumors (SMTs) were found in the lower rectum. Five months later, one of the SMT turned into an ulcerated lesion. The pathological findings of biopsy from the ulcerated lesion showed moderately differentiated adenocarcinoma. An abdominoperineal resection was performed. Histopathological examination showed two tumors, a 38×28mm ulcerated lesion and a 15mm SMT, which were both moderately differentiated adenocarcinoma. Immunohistological staining demonstrated that all tumors were CK7 (-) and CK20 (+). The rectal tumors were compatible with the primary carcinoma. Consequently, the tumors were diagnosed with metachronous intramural metastases of the primary descending colon cancer.
