Long-term survival after neck lymph node metastases from sigmoid colon cancer--a case report

We report a 73-year-old female who had been operated on for sigmoid colon cancer and neck lymph node metastases. Tumor size was controlled by systemic chemotherapy for about 3 years. During the chemotherapy, toxicity over grade 2 was not observed and good QOL was maintained on an outpatient basis. It is suggested that low-dose systemic chemotherapy may be useful for patients with poor general status.     

Isolated splenic metastasis of sigmoid colon cancer: a case report

We report the case of a 62-year-old man who developed isolated splenic metastasis of sigmoid colon cancer. The patient underwent left hemicolectomy for Dukes C sigmoid colon cancer in February 1997. In March 1999, an abdominal CT scan revealed a tumor 3 cm in size at the inferior pole of the spleen. The tumor was hyperechoic on ultrasonography. The serum carcinoembryonic antigen level was normal. Since no other site of recurrence was identified, a splenectomy was performed with a curative intent. At laparotomy, neither hepatic metastasis, peritoneal dissemination, lymph node metastasis nor local recurrence was detected. Histological findings of the splenic tumor were compatible with metastasis of the previously resected sigmoid colon adenocarcinoma. The patient has been disease-free for 19 postoperative months. Immunohistochemical staining for urokinase-type plasminogen activator was positive in primary sigmoid colon cancer and splenic metastasis, but negative in lymph node metastasis; results that possibly reflect the difference in progenitor cells between splenic metastasis and lymph node metastasis or the difference in the microenvironment of cancer cells between the spleen and lymph nodes. Based on the present case, we recommend that clinicians pay close attention to the spleen for the early diagnosis of isolated splenic metastasis when routinely evaluating abdominal CT scans and abdominal ultrasonography following curative resection of primary colorectal cancer.     

Heart metastasis of gallbladder cancer--a case report

A 42-year-old man with gall bladder cancer was given a pancreatoduodenectomy. Chest-roentgenograms revealed a prominence of the left cardiac silhouette 6 months after operation. Two months later, the patient developed exertional dyspnea and chest pain. A diagnosis of heart metastasis of gall bladder cancer was established by aspiration cytology. Intravenous administration of 5-FU and cis-DDDP proved ineffective in controlling the disease. The patient died 14 months after operation. An autopsy revealed metastasis to the left ventricle of the heart. This is the 6th such case of gallbladder cancer in the literature.     

A resected case of gastric regional lymph node metastasis from ascending colon cancer

A 67-year-old man underwent right hemi-colectomy for ascending colon cancer in 2007. One year later, he was diagnosed as early gastric cancer, and endoscopic submucosal dissection was performed. Pathologically, cancer cells were detected on the vertical margin, so we conducted distal gastrectomy. A dissected lymph node around the hepatic artery was histologically proved to contain adenocarcinoma cells. The cancer cells were positive for CK20. Colon cancer cells were also positive for CK20 but gastric cancer cells were focally positive for CK20. This pattern of CK staining suggested the ascending colon cancer metastasized to a gastric regional lymph node.     

Successfully resected advanced gastric carcinoma after combined chemotherapy of TS-1 plus CDDP--a case report

A 66-year-old man complained of epigastralgia and a close examination was done. A type 3 gastric carcinoma was found. The tumor invading the pancreas and swelling lymphnodes around the stomach were confirmed according to abdominal CT. We considered it difficult to resect the tumor completely, and so we used combined chemotherapy of TS-1 plus CDDP. TS-1 was taken at 120 mg/day for 28 days followed by 14 days rest. CDDP was injected at 140 mg on day 8. Because the tumor in the stomach changed to scar and swelling lymphnodes diminished after two courses of therapy, total gastrectomy was done. After operation, combined chemotherapy of LV and 5-FU resulted in no recurrence to date. Although combined chemotherapy of TS-1 plus CDDP is effective for advanced gastric carcinoma, the number of days TS-1 is taken and the duration of the preoperative chemotherapy must be investigated in forthcoming study.     

A case of resected spinal metastasis following colectomy and hepatectomy for descending colon carcinoma

The patient was a 49-year-old man. In 1995, he underwent left hemicolectomy for descending colon carcinoma, and in 1996, partial hepatic resection was performed for liver metastasis. Post-operative chemotherapy was performed with 5'-DFUR. Five years later, he had lumbar and femoral pain. X-ray and MRI examination revealed a compression fracture and a spinal tumor at the XII thoracic vertebra. Though chemoradiotherapy was performed, the symptoms of pain, numbness and muscle weakness progressed. A resection of the metastatic spinal tumor was performed. Following several systemic chemotherapies, such as 5-FU/l-LV, CPT-11 + 5-FU/l-LV and low-dose CPT-11/UFT, radiotherapy was performed for the progressed bone tumor. At 2 years after surgery, he is still able to walk and no other site of recurrence has been detected.     

Metastasis of sigmoid colon cancer in cryptorchid testis: report of a case

Isolated testicular metastasis from colorectal cancer is considered an unusual event. In this case report we describe for the first time a metastasis from an adenocarcinoma of the sigmoid colon to a cryptorchid testis. The patient developed a painless testicular nodule three years after the diagnosis of primary sigmoid colon cancer. Recent reports have suggested that the incidence of genitourinary abnormalities in human males has increased over the past 50 years; in particular, cryptorchid testes increase the clinical risk factors for primary or metastatic testicular cancer. In conclusion, there should be awareness of the risk of metastasis of colorectal cancer to the testis in the workup of patients with testicular symptoms. Furthermore, patients with colorectal cancer and cryptorchidism should be managed with a single surgical intervention: when the primary colorectal tumor is removed, the cryptorchid testicle should also be removed to reduce the risk of late metastases.     

Association of adenocarcinoma and leiomyosarcoma of the sigmoid colon. A case report

Malignant tumors of the gastro-intestinal tract showing both carcinomatous and sarcomatous components are rare. Very few cases were described in the stomach and only one case in the colon. We describe a second case of a tumor of the sigmoid colon showing adenocarcinoma intermingled with leiomyosarcoma elements.     

A case of peritoneal disseminated sigmoid colon cancer with liver metastasis responding to S-1

In October 2004, a 73-year-old man underwent loop ileostomy because of unresectable peritoneal disseminated sigmoid colon cancer with liver metastasis. The oral chemotherapy by S-1 was administered(80 mg/day for 4 weeks followed by a 2-week rest period). A half year later, the primary lesion was remarkably diminished on barium enema, and peritoneal dissemination and liver metastasis disappeared on CT. Because he was unwilling to have an ileostomy, we decided to resect the primary lesion and close the ileal stoma in May 2005. There was no obvious peritoneal dissemination, and operation was successful. He died without intestinal stoma one year after second operation. This therapy can be orally administered at home, and is considered to be useful from the viewpoint of QOL as well. S-1 is expected to be an effective agent for the treatment of colon cancer.     

Tubular adenoma with squamous metaplasia of the sigmoid colon: A case report

A case of tubular adenoma with squamous metaplasia of the sigmoid colon in a 44-year-old female is reported. The tumor was a pedunculated polyp with a size of 1.2 × 1.7 × 1.7 cm. Histologically, the tumor showed tubular adenoma with focal squamous metaplasia. Borderline atypia was noted in a part of adenoma without squamous metaplasia and squamous component. It is supposed that squamous epithelial polyp, squamous cell carcinoma, adenosquamous carcinoma, and mucoepidermoid carcinoma may be derived from colonic adenoma with squamous metaplasia. Only six cases of the adenoma with squamous metaplasia of the large intestine have been reported previously in the literature.     

Brain metastases of colorectal cancer--a case report

Metastatic brain tumors from colorectal cancers are relatively rate. In previous reports, the incidence, ranged from 1.9 to 3.5 percent of all metastatic brain tumors. We reported 2 cases of metastatic brain tumors from colorectal cancers. Metastasis to the lung and liver were not found in 2 cases at the time of the diagnosis of the single brain metastasis. The CEA levels in the serum were highly elevated in these 2 cases. On a contrast-enhanced CT scan, tumors were equally demonstrated as high density and cystic, with a ring-like mass with surrounding brain edema. Brain metastases of colorectal cancer were discussed with a review of the literature.     

Hepatic metastasis from gastric GIST radically resected after imatinib mesylate therapy-a case report

We report a case of hepatic metastasis from gastric gastrointestinal stromal tumor (GIST), which was safely resected with preoperative imatinib therapy. A 60-year-old woman was hospitalized and underwent a treatment for hepatic SOL at another hospital prior to gastric GIST resection. Computed tomography revealed a tumor compressing the right and middle hepatic vein. The tumor volume decreased after an initiation of imatinib therapy aimed at preserving the middle hepatic vein. Although tumor volume was further decreased over the course of twelve months, a new lesion appeared, suggesting a progressive disease. Our findings suggest that a radical resection of gastric GIST to preserve the middle hepatic vein is possible.     

A case report of thyroid gland metastasis associated with lung metastasis from colon cancer

Thyroid gland metastasis of malignant tumors is observed in 1.9% to 9.5% of histologically examined autopsy cases. Thyroid metastasis from colon cancer is extremely rare and the prognosis is poor. Here we report a case of lung metastasis and thyroid gland metastasis following sigmoid colon cancer surgery. In 2000, a 58-year-old woman underwent a sigmoid colectomy for sigmoid colon cancer. In 2005, a metastatic lung tumor was detected by chest CT. The patient underwent a partial thoracoscopic resection of the left lung in April 2005. On a CT scan taken 3 years and 4 months after the lung resection, a tumor mass was observed in the left lung and a low-absorption region with an unclear border was seen in the left lobe of the thyroid gland. Thyroid aspiration cytology showed adenocarcinoma, and a diagnosis of thyroid gland metastasis from sigmoid colon cancer was made. In April 2008 a subtotal thyroidectomy was performed. Following surgery, the patient underwent chemotherapy with mFOLFOX6 and bevacizumab. Nevertheless a number of lung metastases and expressions of lung metastasis were subsequently observed. Histopathological examination revealed a number of metastases of differentiated papillary adenocarcinoma in the thyroid gland from colon cancer.     

A case report of poorly-differentiated adenocarcinoma in sigmoid colon cancer with liver and pulmonary metastasis responding to TS-1 and CPT-11

A 66-year-old woman (156 cm, 58 kg) underwent sigmoid colectomy for cancer. She was found to have simultaneous liver and peritoneal metastases at operation, which had not been detected with CT examination before operation. After operation, CT showed multiple liver metastasis and a high level of CEA and CA19-9 . Pathological findings were type 3, 30 x 20 mm, poorly-differentiated adenocarcinoma, se, ly 2, v 2, n 2 (+), ow (-), aw(-), H 3, P 0 (stage IV). Treatment of the patient consisted of daily oral administration of 80 mg TS-1 for 21 days and 60 mg CPT-11 on 1 day and 15 day as one course.After 2 courses, tumor sizes of liver metastases and the level of tumor markers became reduced.The current case suggested that the administration of TS-1 and CPT-11 may have a potent therapeutic efficacy in advanced colorectal cancer.     

Single colon metastasis from breast cancer: a clinical case report

Metastatic involvement of the extrahepatic digestive system is rare. We here report the case of a 62-year-old woman who presented with a bowel obstruction related to a metastasis of breast cancer occurring 12 years after a mastectomy for lobular carcinoma. No other distant metastases were detected except for two nodules of 20 and 5 mm on the right chest wall. Biopsy of the larger nodule showed a lobular carcinoma. The patient underwent a right hemicolectomy and then received chemotherapy combined with letrozole, resulting in a partial response. The literature revealed only a few cases of breast cancer metastatic to the colon. Patients with known breast cancer, particularly of the lobular histological type, who present with specific or less specific abdominal symptoms or signs such a microcytic anemia, should be endoscopically explored in order to detect possible metastases of the primary breast tumor.     

A case whose lung metastasis was detected and resected eleven years after resection of primary colon cancer

In July 1999, a 79-year-old man underwent sigmoidectomy and D3 lymphadectomy for sigmoid colon cancer (ss, n(-), stage II, cur A). In September 2000, hepatectomy of right lobe and cholecystectomy were performed for his liver metastasis. Every three to six months follow-up had been kept since adjuvant chemotherapy (200 mg/day of 5-FU per os for two years) completed. Eleven years and two months after sigmoidectomy (in September 2010), a chest X-ray examination detected a small nodule in upper area of his right lung, which was diagnosed as either primary lung cancer or metastatic lung tumor followed by chest CT scan and PET-CT examination. In November 2010, laparoscopy-assisted partial resection of his right lung was performed. Histochemical examination of the resected lung tumor resulted cytokeratin 7(-), cytokeratin 20(+) and TTF-1(-), confirming its final diagnosis as lung metastasis from sigmoid colon cancer. He has been alive for six months without any recurrence since resection of his lung metastasis. It was a very rare case to have more than ten-year interval between colon cancer resection and detection of its lung metastasis. However, when we diagnosed the patient with lung tumor, who had undergone a colorectal resection, we should consider if he had a lung metastasis from colorectal cancer.     

Multidisciplinary treatment for advanced bladder cancer--a case report

The patient was a 63-year-old woman who had been diagnosed with advanced bladder cancer with renal dysfunction and bilateral bulky pulmonary metastasis. Initially, the primary lesion was resected and the implantation of an infusion catheter and port system was performed. Following surgery, she received intermittent intra-arterial (IA) low-dose CDDP chemotherapy via the infusion port and concurrent bronchial arterial infusion and radiation (40 Gy for the left lung). About 3 months later, the right and left lung metastases were reduced 63% and 91%, respectively, and a right lower lobectomy was performed. CDDP was administered through the outpatient clinic ever since. From January 2001, we began to use docetaxel (TXT) for CDDP because of continuous grade 2 nausea and appetite loss. There were no adverse effects by TXT. Repeated IA chemotherapy was discontinued from June 2001 because of neurological symptoms. In September 2001, a left skull base metastasis was detected and was treated by radiation 40 Gy. In November 2002, a left patella metastasis appeared and was treated by IA chemotherapy with angiotensin II and radiation 30 Gy. We confirmed that multidisciplinary treatment contributed to her approximately 3-year survival with good QOL. The cancers in both lungs could be kept under control until her death.     

Effective alendronate therapy against a bone metastasis occurring during docetaxel therapy for breast cancer--a case report]

A 65-year-old woman underwent radical operation for breast cancer in December, 1992. Between September, 1994 and January, 1997, she developed local recurrences four times as well as a supraclavicular lymph node recurrence. Each recurrence was treated with surgery and various types of chemoendocrine therapy, including anthracycline-containing chemotherapy. In April, 1997, she had developed a liver metastasis, which showed a partial response to docetaxel therapy. However, she developed a bone metastasis in January, 1998 (9 months after the initiation of docetaxel therapy). In addition to the docetaxel therapy, she was treated with a potent bisphosphonate, alendronate, 10 mg of which was infused every two weeks. Eight alendronate infusions resulted in a marked improvement in the bone metastasis, and the liver metastasis has been in regression for 13 months in response to the docetaxel therapy. In conclusion, alendronate is a promising agent against bone metastases which occur during docetaxel therapy for breast cancer.