A CASE OF SUBMUCOSAL INVASIVE RECTAL CANCER WITH ISOLATED OBTURATOR LYMPH NODE METASTASIS

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  • 孤立性に閉鎖リンパ節転移をきたした下部直腸ＳＭ癌の１例

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Abstract

A 75-year-old man was seen at the hospital because of anal bleeding on defecation in April 2005. Colonoscopy showed a type IIa lesion at the lower rectum, and then endoscopic mucosal resection (EMR) was performed on June 9. The histopathological diagnosis was moderately differentiated adeocarcinoma, SM (800μm), ly1, and v0. Low anterior resection of rectum was performed on June 30. The clinical stage was SM, N0 (0/8), H0, M0, P0, and Stage I. After discharge, the patient was seen at the hospital because of the abrupt onset of high fever and unconsciousness. Abdominal CT scan showed an increase in a tumor in the vicinity of the lower part of ureter and left internal iliac artery which had been diagnosed as thrombotic aneurysm at the former abdominal CT scan. A part of the ureter upward from the tumor remarkably dilated, so that obstruction of the ureter and acute pyelonephritis were diagnosed. Following drainage of the ureter, FDG-PET examination and CT-guided needle biopsy were performed for exploration of the tumor. The histopathological diagnosis was metastasis of rectal carcinoma to the obturator lymph node, and the metastatic lesion was diagnosed as solitary because no other metastatic lesions were seen. No more increase in the tumor size had been observed with chemoradiotherapy, but he died of respiratory failure due to multiple lung metastases on June 16, 2006.<br>It is very rare that submucosal invasive cancer of the rectum metastasizes solitarily to the main lymph nodes like in this case.

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