A Case of Ascending Colon Cancer with Synchronous Small Intestinal Metastases in Six Locations

Abstract

A 71-year-old woman presented with shortness of breath and unsteadiness, her blood tests showed anemia, and she was then seen at our hospital. Abdominal computed tomography showed a mass with a maximum diameter of about 5 cm in the ascending colon and regional lymph node enlargement, but there were no signs of distant metastases or peritoneal dissemination. Lower gastrointestinal endoscopy showed a circumferential type 2 lesion in the ascending colon, which was histologically diagnosed as moderately differentiated adenocarcinoma. Cancer of the ascending colon with regional lymph node metastasis was therefore diagnosed, and open ileocecal resection was planned. Intraoperatively, in addition to the main lesion in the ascending colon, tumors were also found at six different locations in the small intestine, between 20 cm and 120 cm from the proximal side of the terminal ileum, and two parts of the small intestine were also resected. On gross observation, the resected small intestinal tumors comprised four type 2 tumors located mainly in the muscularis layer and two submucosal tumors. Histopathologically, the ascending colon cancer was highly differentiated adenocarcinoma [T3(A), N0, ly1, v2], and the small intestinal tumors were all adenocarcinomas with similar characteristics. Ascending colon cancer with multiple small intestinal metastases in six locations was diagnosed.