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Indian Journal of Cancer, Vol. 48, No. 2, April-June, 2011, pp. 267-268 Letter to Editor Isolated metastasis to colon from carcinoma cervix M Singla1, R Singal1, S Singla1, P Sahu1, S Kaur2, YR Goyal1 1 Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India Correspondence Address: R Singal Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, Haryana India singalrikki@yahoo.com Code Number: cn11068 DOI: 10.4103/0019-509X.82893 Sir, Primary squamous cell carcinoma (SCC) of the colon is a rare entity and secondary carcinomas are even more unusual. Proposed mechanisms of SCC development include proliferation of uncommitted stem cells and squamous metaplasia of adenomas and adenocarcinoma. [1] A 48-year female was admitted in the emergency department with subacute intestinal obstruction. There was also associated off and on pain in right hypochondrium, and anorexia of 4 months duration. Clinical examination revealed a 4 cm × 4 cm hard mobile lump in the right hypochondrium. Abdominal ultrasound showed a heterogeneous mass at the hepatic flexure of the colon of size approximately 3.8 cm × 4.5 cm with proximal dilated bowel loops. The patient had been previously diagnosed as a case of carcinoma cervix without involvement of surrounding organs. Histological diagnosis was keratinizing SCC of cervix. Patient was treated by external and internal beam irradiation without any surgery. There was no evidence of loco-regional recurrence during follow up over 2 years and serial Papanicolau smears were negative. After a follow up of 2 years, she developed altered bowel habits, with pain and lump in right hypochondrium. Laparotomy revealed a single hard, mobile lump at the hepatic flexure of colon of size 4 cm × 6 cm. Right extended hemicolectomy and ileo-transverse anastomosis was done. Histopathological examination revealed secondary SCCs at the hepatic flexure of colon with involvement of the muscularis. The patient received another course of radiotherapy. She was followed up for the next 2 years and was asymptomatic. Reports of metastatic tumors in the transverse colon are scarce, most of them being metastasis from disseminated carcinoma in the form of peritoneal seedlings. [1],[2] Although colonic metastasis have been reported from primary cancers of organs such as breast, cervix, kidney, ovary, and malignant melanomas, [2],[3],[4] the pathogenesis of SCC of the colon is unclear due to its rarity. In 1979, Williams et al., proposed three criteria for primary SCC of the colon: (a) metastasis from other sites must be excluded; (b) squamous epithelial lined fistulous tract must not involve the affected bowel because it may be a source of SCC; and (c) SCC of the anus with proximal extension must be excluded. [5] De Jode reported a case of cervical carcinoma recurring after 16 months of radiotherapy and presenting as a primary tumor of the cecum. [6] Metastasis from cervical carcinoma may be of two types: (a) a mesenteric mass extending into the bowel wall (b) intramural masses eventually ulcerating into the bowel. In the absence of clinical evidence of other secondary carcinomas and apparently after the successful treatment of the primary lesion, hematogenous spread is most likely in our case, though the possibility of retrograde lymphatic permeation could only be excluded by lymphangiography. However, in our case the absence of lymph nodal enlargement suggests that lymphatic spread was unlikely. Early detection with prompt intervention is the key factor required in the successful management of the secondary tumors and to improve the overall survival of the patient. References
Copyright 2011 - Indian Journal of Cancer |
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