Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?

World Journal of Surgical Oncology

Case Report

Mathew H Chung¹  Christopher R Mascarenhas¹  Alan T Davis¹  Jill K Onesti¹ 

[1] GRMEP/MSU General Surgery Residency Program, 1000 Monroe Ave.NW, 49503, Grand Rapids, MI, USA;Michigan State University Department of Surgery, Sparrow Professional Building, 1200 E. Michigan Ave, 48912, Lansing, MI, USA;

关键词: colon cancer;    metastasis;    scapula;   

DOI  :  10.1186/1477-7819-9-137

 received in 2011-07-22, accepted in 2011-10-26,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundDistant metastases from colon cancer spread most frequently to the liver and the lung. Risk factors include positive lymph nodes and high grade tumors. Isolated metastases to the appendicular skeleton are very rare, particularly in the absence of identifiable risk factors.Case reportThe patient was a 55 year old male with no previous personal or family history of colon cancer. Routine screening revealed a sigmoid adenocarcinoma. He underwent resection with primary anastomosis and was found to have Stage IIA colon cancer. He declined chemotherapy as part of a clinical trial, and eight months later was found to have an isolated metastasis in his right scapula. This was treated medically, but grew to 12 × 15 cm. The patient underwent a curative forequarter amputation and is now more than four years from his original colon surgery.DiscussionStage IIA colon cancers are associated with a high five year survival rate, and chemotherapy is not automatically given. If metastases occur, they are likely to arise from local recurrence or follow lymphatic dissemination to the liver or lungs. Isolated skeletal metastases are quite rare and are usually confined to the axial skeleton. To our knowledge, this is the first reported case of an isolated scapular metastasis in a patient with node negative disease. The decision to treat the recurrence with radiation and chemotherapy did not reduce the tumor, and a forequarter amputation was eventually required.ConclusionThis case highlights the importance of adequately analyzing the stage of colon cancer and offering appropriate treatment. Equally important is the early involvement of a surgeon in discussing the timing of the treatment for recurrence. Perhaps if the patient had received chemotherapy or earlier resection, he could have been spared the forequarter amputation. The physician must also be aware of the remote possibility of an unusual presentation of metastasis in order to pursue timely work up.

【 授权许可】

Unknown   
© Onesti et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.