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Abstract：
BACKGROUND: Colorectal cancer (CRC) often metastasizes to the liver, lungs, lymph nodes, and peritoneum but rarely to the bladder, small intestine, and skin. We here report the rare metastasis of anal cancer in the left bladder wall, followed by metastases to the small intestine and skin, after abdominoperineal resection and left lateral lymph node dissection with chemotherapy in a patient with clinician Stage IVa disease.
METHODS: A 66-year-old man presented with 1-month history of bloody stool and anal pain and diagnosed with clinical Stage IVa anal cancer with lymph node and liver metastases (cT3, N3 [#263L], M1a [H1]). Systemic chemotherapy led to clinical complete response (CR) for the liver metastasis and clinical near-CR for the primary tumor. Robot-assisted laparoscopic perineal rectal resection and left-sided lymph node dissection were performed. Computed tomography during 18-month postoperative follow-up identified a mass in the left bladder wall, which was biopsied with transurethral resection, was confirmed as recurrent anal cancer by histopathologic evaluation. After two cycles of systemic chemotherapy, partial resection of the small intestine was performed due to bowel obstruction not responding to conservative therapy. The histopathologic evaluation revealed lymphogenous invasion of the muscularis mucosa and subserosa of all sections. Ten months after the first surgery for bowel obstruction and two months before another surgery for obstruction of the small intestine, skin nodules extending from the lower abdomen to the thighs were observed. The histopathologic evaluation of the skin biopsy specimen collected at the time of surgery for small bowel obstructions led to the diagnosis of skin metastasis of anal cancer. Although panitumumab was administered after surgery, the patient died seven months after the diagnosis of skin metastasis.
CONCLUSIONS: This case illustrates the rare presentation of clinical Stage IVa anal cancer metastasizing to the bladder wall, small intestine, and skin several years after CR to chemotherapy.
METHODS: A 66-year-old man presented with 1-month history of bloody stool and anal pain and diagnosed with clinical Stage IVa anal cancer with lymph node and liver metastases (cT3, N3 [#263L], M1a [H1]). Systemic chemotherapy led to clinical complete response (CR) for the liver metastasis and clinical near-CR for the primary tumor. Robot-assisted laparoscopic perineal rectal resection and left-sided lymph node dissection were performed. Computed tomography during 18-month postoperative follow-up identified a mass in the left bladder wall, which was biopsied with transurethral resection, was confirmed as recurrent anal cancer by histopathologic evaluation. After two cycles of systemic chemotherapy, partial resection of the small intestine was performed due to bowel obstruction not responding to conservative therapy. The histopathologic evaluation revealed lymphogenous invasion of the muscularis mucosa and subserosa of all sections. Ten months after the first surgery for bowel obstruction and two months before another surgery for obstruction of the small intestine, skin nodules extending from the lower abdomen to the thighs were observed. The histopathologic evaluation of the skin biopsy specimen collected at the time of surgery for small bowel obstructions led to the diagnosis of skin metastasis of anal cancer. Although panitumumab was administered after surgery, the patient died seven months after the diagnosis of skin metastasis.
CONCLUSIONS: This case illustrates the rare presentation of clinical Stage IVa anal cancer metastasizing to the bladder wall, small intestine, and skin several years after CR to chemotherapy.
摘要：
背景：结直肠癌（CRC）经常转移到肝脏，肺,淋巴结,和腹膜，但很少到膀胱，小肠,和皮肤。我们在这里报道左侧膀胱壁肛门癌的罕见转移，然后转移到小肠和皮肤，在临床医生IVa期疾病患者的腹部手术切除和左外侧淋巴结清扫联合化疗后。
方法：一名66岁男子，有1个月的便血和肛门疼痛病史，诊断为临床IVa期肛门癌，伴有淋巴结和肝转移（cT3，N3[＃263L]，M1a[H1])。全身化疗导致肝转移的临床完全反应（CR）和原发性肿瘤的临床近CR。采用机器人辅助腹腔镜会阴直肠切除术及左侧淋巴结清扫术。术后18个月随访期间，计算机断层扫描发现左侧膀胱壁肿块，经尿道切除活检，通过组织病理学评估证实为复发性肛门癌。经过两个周期的全身化疗，由于对保守治疗无效的肠梗阻，进行了小肠部分切除术。组织病理学评估显示，所有切片的肌层粘膜和浆膜下都有淋巴入侵。第一次肠梗阻手术后10个月，另一次小肠梗阻手术前2个月，观察到从下腹部到大腿的皮肤结节。对小肠梗阻手术时收集的皮肤活检标本进行组织病理学评估，从而诊断出肛门癌的皮肤转移。尽管帕尼单抗是在手术后服用的，患者在诊断为皮肤转移7个月后死亡。
结论：该病例说明了临床IVa期肛门癌转移到膀胱壁的罕见表现，小肠,和皮肤在CR后几年接受化疗。
方法：一名66岁男子，有1个月的便血和肛门疼痛病史，诊断为临床IVa期肛门癌，伴有淋巴结和肝转移（cT3，N3[＃263L]，M1a[H1])。全身化疗导致肝转移的临床完全反应（CR）和原发性肿瘤的临床近CR。采用机器人辅助腹腔镜会阴直肠切除术及左侧淋巴结清扫术。术后18个月随访期间，计算机断层扫描发现左侧膀胱壁肿块，经尿道切除活检，通过组织病理学评估证实为复发性肛门癌。经过两个周期的全身化疗，由于对保守治疗无效的肠梗阻，进行了小肠部分切除术。组织病理学评估显示，所有切片的肌层粘膜和浆膜下都有淋巴入侵。第一次肠梗阻手术后10个月，另一次小肠梗阻手术前2个月，观察到从下腹部到大腿的皮肤结节。对小肠梗阻手术时收集的皮肤活检标本进行组织病理学评估，从而诊断出肛门癌的皮肤转移。尽管帕尼单抗是在手术后服用的，患者在诊断为皮肤转移7个月后死亡。
结论：该病例说明了临床IVa期肛门癌转移到膀胱壁的罕见表现，小肠,和皮肤在CR后几年接受化疗。
