A CASE OF MULTIPLE SIGMOID COLON CANCER WITH NON-INVASIVE METASTASIS TO THE SMALL INTESTINE

Abstract

We report a case of multiple sigmoid colon cancer with non-invasive metastasis to the small intestine.
A 62-year-old man was seen at the hospital because of dizziness and general fatigue since February 2002. Except for anemia detected on admission, there were no biochemical abnormalities. Slightly high levels of tumor markers were noted; CEA was 5.8ng/ml and CA19-9 was 181U/ml. Barium enema study revealed two filling defects in the sigmoid colon, and colonofiberscopy also showed a type 3 tumor according to ‘Japanese Classification of Colorectal Carcinoma’. The patient was operated on with a diagnosis of multiple sigmoid colon cancer. Besides the two sigmoid tumors, three tumors were found in the small intestine which were about 120cm distal from the Treiz' ligament, and 15 and 25cm from the ileum end during surgery. A sigmoidectomy (D3) and enterectomies at two portions of the small intestine were carried out. No malignant cells were demonstrated by peritoneal lavage cytology. Histopathologically these sigmoid and small intestinal lesions were moderately differentiated adenocarcinoma; the sigmoid colon cancer showed extremely severe venous invasion and the small intestinal lesions were mainly located in the submucosal structure. Accordingly non-invasive metastasis to the small intestine of sigmoid colon cancer was diagnosed. The patient has been treated with chemotherapy including 5FU, and recovered his social activities without recurrence, as of 2 years 7 months after the operation.
To the best of our knowledge, there have been only eight cases of non-invasive metastasis to the small intestine like this case.