A Case of Metastatic Colon Cancer from Duodenal Cancer 7 Years after Curative Resection

Kiyotomi Maruyama, Yasuo Yamazaki and Kenji Uchida

Department of Surgery, Ageo Kohsei Hospital

A 65-year-old woman was admitted to our hospital because of fecal occult bleeding. She had undergone curative pylorus-preserving pancreatoduodenectomy for duodenal cancer 7 years previously (T4, tub1, ly0, v0, n0, H0, P0, M0, stage IIIA). Barium enema showed a tumor of 2 cm in diameter in the transverse colon. Colonoscopy revealed an elevated lesion 1.5 cm in diameter with ulceration on its top. Histological examination of biopsy specimens revealed well differentiated adenocarcinoma. Partial resection of the transverse colon was performed. Histopathological examination revealed irregular atypical ducts of various size from the serosa to the submucosa, indicating well differentiated adenocarcinoma. Lymph vessel invasion was observed, but the specimen was negative blood vessel invasion. And then No. 223 lymph node metastase was detected (wel, ss, v₀, ly₁, n₃ (+) (No. 223), stage IIIb). The features of the lesions were compatible with the histological findings in the previously resected duodenal cancer. Metastatic colon cancers have been reported to occur in 0.1%-1% of colon cancers, and the most common form of metastase are the tethering type. We encountered a solitary metastatic cancer in the colon. This case is a warning that metastatic colon cancers can be diagnosed more than 7 years after primary resection of duodenal cancer, and that periodic checkups for colon cancer are necessary after duodenal cancer operations. Despite the poor prognosis of metastatic colon cancer, curative operation should be attempted in the absence of other metastase.

Key words
metastatic colon cancer, colon cancer, duodenal cancer

Reprint requests
Kiyotomi Maruyama Department of Surgery, Ageo Kohsei Hospital
421-1 Jitohgata, Ageoshi, 362-0051 JAPAN

Accepted
December 19, 2003

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