A Case of Maltiple Hematogenous Metastatic Colon Cancer from Duodenal Carcinoma

Tomo Nakagawa, Tsunekazu Mizushima, Toshikazu Ito, Hitoshi Mizuno, Yuko Udatsu, Keijiro Sugimura, Akira Tomokuni, Masami Imakita*, Kazuhiro Iwase** and Masaaki Izukura

Department of Surgery and Department of Pathology*, Rinku General Medical Center, Izumisano Municipal Hospital
Department of Surgery, Osaka General Medical Center**

A 69-year-old man who had undergone pylorus preserving pancreatoduodenectomy for duodenal carcinoma 2 years earlier experienced abdominal distension, then ileus 2 months later. Colonoscopy showed circumferential strictures of the hepatic flexure, transverse colon, and sigmoid colon but no malignancy in mucosal or submucosal biopsy. Abdominal CT showed thickening of the intestinal wall of the ascending colon, sigmoid colon, and cecum. FDG-PET showed accumulation in the transverse colon. Intestinal metastasis from duodenul carcinoma was suspected, but benign strictures could not be denied. Right hemicolectomy and sigmoidectomy yielded a pathological diagnosis of well differentiated adenocarcinoma of the submucosa and muscularis externa compatible with hematogenous metastasis to the intestine from duodenal carcinoma. Cases of intestinal metastasis hematogenously from duodenal carcinoma are very rare.

Key words
metastatic colon cancer, duodenal carcinoma

Reprint requests
Tsunekazu Mizushima Department of Surgery, Rinku General Medical Center, Izumisano Municipal Hospital
2-23 Rinku Ohrai Kita, Izumisano, 598-0048 JAPAN

Accepted
July 23, 2008

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