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Late recurrence of large peri-stomal metastasis following abdomino-perineal resection of rectal cancer.

Vijayasekar C, Noormohamed S, Cheetham MJ - World J Surg Oncol (2008)

Bottom Line: The gross appearance initially suggested possibility of a true metachronous cancer with peristomal spread.But histopathology of the resected specimen showed no colonic mucosal involvement suggesting a true large cutaneous peristomal metastasis which has not been reported previously.Any unusual skin lesions especially on the abdominal wall skin, previous incision scars or near the stoma should be biopsied early to rule out metastatic disease and systematic work-up should be carried out to rule out any metachronous tumour or metastasis elsewhere in the body.

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Affiliation: Department of surgery, Royal Shrewsbury Hospital, Shrewsbury, SY3 8XQ, UK. cvijayasekar@hotmail.com

ABSTRACT

Background: Cutaneous metastasis from colorectal cancer after excision of the primary is a rare occurrence and presents as cutaneous or subcutaneous nodules or as a rash commonly on the anterior abdominal wall.

Case presentation: This is a case description of the management of a large fungating peristomal cutaneous metastasis occurring 14 years after abdomino-perineal excision of the primary cancer. The gross appearance initially suggested possibility of a true metachronous cancer with peristomal spread. But histopathology of the resected specimen showed no colonic mucosal involvement suggesting a true large cutaneous peristomal metastasis which has not been reported previously. Literature review of presentation, management and prognosis of cutaneous metastasis from colorectal cancer is described

Conclusion: Cutaneous metastasis following colorectal cancer resection is a well-recognised entity though rare. Any unusual skin lesions especially on the abdominal wall skin, previous incision scars or near the stoma should be biopsied early to rule out metastatic disease and systematic work-up should be carried out to rule out any metachronous tumour or metastasis elsewhere in the body.

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Completed excision wound with end ileostomy.
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Figure 4: Completed excision wound with end ileostomy.

Mentions: At operation, the mass and the adjacent colostomy were excised wide with generous margins and placed in a bowel bag to avoid any tumour seeding (figure 3). A midline Laparotomy was then performed. There was no evidence of any intra-abdominal metastasis and a curative resection of the mass with en bloc completion colectomy was performed (Figure 4). The large 17 × 14 cms defect was covered with V.A.C® (KCI) dressing and an end ileostomy was constructed in the right iliac fossa (figure 5). She made an uneventful post-operative recovery and after 19 days of V.A.C® therapy a meshed split skin graft was harvested from the anterior thigh and used to resurface the abdominal wound.


Late recurrence of large peri-stomal metastasis following abdomino-perineal resection of rectal cancer.

Vijayasekar C, Noormohamed S, Cheetham MJ - World J Surg Oncol (2008)

Completed excision wound with end ileostomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2542374&req=5

Figure 4: Completed excision wound with end ileostomy.
Mentions: At operation, the mass and the adjacent colostomy were excised wide with generous margins and placed in a bowel bag to avoid any tumour seeding (figure 3). A midline Laparotomy was then performed. There was no evidence of any intra-abdominal metastasis and a curative resection of the mass with en bloc completion colectomy was performed (Figure 4). The large 17 × 14 cms defect was covered with V.A.C® (KCI) dressing and an end ileostomy was constructed in the right iliac fossa (figure 5). She made an uneventful post-operative recovery and after 19 days of V.A.C® therapy a meshed split skin graft was harvested from the anterior thigh and used to resurface the abdominal wound.

Bottom Line: The gross appearance initially suggested possibility of a true metachronous cancer with peristomal spread.But histopathology of the resected specimen showed no colonic mucosal involvement suggesting a true large cutaneous peristomal metastasis which has not been reported previously.Any unusual skin lesions especially on the abdominal wall skin, previous incision scars or near the stoma should be biopsied early to rule out metastatic disease and systematic work-up should be carried out to rule out any metachronous tumour or metastasis elsewhere in the body.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of surgery, Royal Shrewsbury Hospital, Shrewsbury, SY3 8XQ, UK. cvijayasekar@hotmail.com

ABSTRACT

Background: Cutaneous metastasis from colorectal cancer after excision of the primary is a rare occurrence and presents as cutaneous or subcutaneous nodules or as a rash commonly on the anterior abdominal wall.

Case presentation: This is a case description of the management of a large fungating peristomal cutaneous metastasis occurring 14 years after abdomino-perineal excision of the primary cancer. The gross appearance initially suggested possibility of a true metachronous cancer with peristomal spread. But histopathology of the resected specimen showed no colonic mucosal involvement suggesting a true large cutaneous peristomal metastasis which has not been reported previously. Literature review of presentation, management and prognosis of cutaneous metastasis from colorectal cancer is described

Conclusion: Cutaneous metastasis following colorectal cancer resection is a well-recognised entity though rare. Any unusual skin lesions especially on the abdominal wall skin, previous incision scars or near the stoma should be biopsied early to rule out metastatic disease and systematic work-up should be carried out to rule out any metachronous tumour or metastasis elsewhere in the body.

Show MeSH
Related in: MedlinePlus