PDF(Pubmed)
Abstract：
BACKGROUND: Colorectal cancer (CRC) metastasizes to various organs, while cutaneous metastases are rare. Although there have been several previous reports of axillary cutaneous metastases with other metastases of CRC, there has never been a report of axillary cutaneous metastasis of CRC that could be treated with curative-intent surgery.
METHODS: A 68-year-old female was diagnosed with an axillary cutaneous tumor and ascending colon cancer with invasion to the duodenum. Histopathological and immunohistochemical analysis revealed that the axillary cutaneous tumor showed adenocarcinoma and the same expression pattern for cytokeratin 7, cytokeratin 20, and CDX2 as the ascending colon cancer, and that proved to be KRAS-NRAS wild type, MSI-H, and with a BRAF V600E mutation. The patient underwent a two-stage resection with curative intent after receiving neoadjuvant chemotherapy which consisted of one cycle of modified FOLFOX6 followed by two cycles of FOLFOXIRI. During and after the two operations, the patient received a total of nine cycles of modified FOLFOX6 as adjuvant chemotherapy. Two years after the initial surgery, and 1 year and 8 months after the second surgery, the patient is alive without recurrence.
CONCLUSIONS: To the best of our knowledge, this is the first report of axillary cutaneous metastasis of CRC with microsatellite instability-high and BRAF V600E mutation that could be treated with curative-intent surgery. It is important to recognize the presence of such cases for the accurate diagnosis and treatment of CRC with cutaneous metastasis.
METHODS: A 68-year-old female was diagnosed with an axillary cutaneous tumor and ascending colon cancer with invasion to the duodenum. Histopathological and immunohistochemical analysis revealed that the axillary cutaneous tumor showed adenocarcinoma and the same expression pattern for cytokeratin 7, cytokeratin 20, and CDX2 as the ascending colon cancer, and that proved to be KRAS-NRAS wild type, MSI-H, and with a BRAF V600E mutation. The patient underwent a two-stage resection with curative intent after receiving neoadjuvant chemotherapy which consisted of one cycle of modified FOLFOX6 followed by two cycles of FOLFOXIRI. During and after the two operations, the patient received a total of nine cycles of modified FOLFOX6 as adjuvant chemotherapy. Two years after the initial surgery, and 1 year and 8 months after the second surgery, the patient is alive without recurrence.
CONCLUSIONS: To the best of our knowledge, this is the first report of axillary cutaneous metastasis of CRC with microsatellite instability-high and BRAF V600E mutation that could be treated with curative-intent surgery. It is important to recognize the presence of such cases for the accurate diagnosis and treatment of CRC with cutaneous metastasis.
摘要：
背景：结直肠癌（CRC）转移到各种器官，而皮肤转移是罕见的。尽管以前有一些关于腋窝皮肤转移和其他CRC转移的报道，从来没有关于CRC腋窝皮肤转移可通过根治性手术治疗的报道.
方法：一名68岁女性被诊断为腋窝皮肤肿瘤和升结肠癌，并侵犯十二指肠。组织病理学和免疫组织化学分析表明，腋窝皮肤肿瘤显示腺癌，细胞角蛋白7，细胞角蛋白20和CDX2的表达模式与升结肠癌相同，证明是KRAS-NRAS野生型,MSI-H,BRAFV600E突变.患者在接受新辅助化疗后，接受了具有治愈性的两阶段切除术，其中包括一个周期的改良FOLFOX6，然后是两个周期的FOLFOXIRI。在两次手术期间和之后，患者总共接受了9个周期的改良FOLFOX6作为辅助化疗.初次手术两年后,第二次手术后1年8个月，病人还活着，没有复发。
结论：据我们所知，这是首例有微卫星不稳定性高和BRAFV600E突变的CRC腋窝皮肤转移的报告,可通过根治性手术治疗.认识到此类病例的存在对于准确诊断和治疗具有皮肤转移的CRC很重要。
方法：一名68岁女性被诊断为腋窝皮肤肿瘤和升结肠癌，并侵犯十二指肠。组织病理学和免疫组织化学分析表明，腋窝皮肤肿瘤显示腺癌，细胞角蛋白7，细胞角蛋白20和CDX2的表达模式与升结肠癌相同，证明是KRAS-NRAS野生型,MSI-H,BRAFV600E突变.患者在接受新辅助化疗后，接受了具有治愈性的两阶段切除术，其中包括一个周期的改良FOLFOX6，然后是两个周期的FOLFOXIRI。在两次手术期间和之后，患者总共接受了9个周期的改良FOLFOX6作为辅助化疗.初次手术两年后,第二次手术后1年8个月，病人还活着，没有复发。
结论：据我们所知，这是首例有微卫星不稳定性高和BRAFV600E突变的CRC腋窝皮肤转移的报告,可通过根治性手术治疗.认识到此类病例的存在对于准确诊断和治疗具有皮肤转移的CRC很重要。
