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• W2894650824 abstract "SESSION TITLE: Disorders of the Mediastinum 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: The common sites of metastasis from colorectal cancer (CRC) are regional lymph nodes, liver, lung, brain, and bone. Mediastinal lymph node and/or pleural metastasis from CRC without metastasis to the lung is an extremely rare finding and there is a scarce literature available on this condition. We present a case of CRC with metastasis to pleura and mediastinal lymph nodes which occurred after curative resection and adjuvant chemotherapy. CASE PRESENTATION: A 70 y/o male underwent right side hemicolectomy and omentectomy for ascending colon cancer followed by adjuvant chemotherapy. No involvement of regional or distant lymph node or any other organ was seen on the imaging. Around nine months after surgery, the patient was noted to have bilateral large pleural effusions on the restaging CT scan of the chest/abdomen/pelvis. Multiple thoracentesis performed over the course of next few months revealed exudative effusion but failed to demonstrate any malignant cells. No intraabdominal or intrathoracic mass or metastasis was seen on CT scan. A subsequent PET/CT revealed multiple sites of FDG avid mediastinal lymphadenopathy. The sites of pleural effusion were not FDG avid. To obtain a confirmatory diagnosis, EBUS and biopsy of lymph nodes was performed that showed adenocarcinoma with signet ring features. Immunohistochemistry confirmed the diagnosis of metastatic colon cancer. Systemic treatment with chemotherapy was initiated. DISCUSSION: Tumor recurrences in distant organ after CRC resection is usually seen in the liver, lung, brain, and bone. Tumor involvement of other sites like pleura and mediastinal nodes without liver of lung involvement is very unusual. In our case, the pleural fluid cytology was most likely falsely negative for malignancy. The exact mechanism by which the cancer cells metastasize to mediastinal lymph nodes from colon is not clear. Two mechanisms have been postulated. One of them is hematogenous route via the paravertebral venous plexus in a patient with distant organ metastasis like ovarian metastasis. The other route is retrograde lymph node metastasis via thoracic duct from a retroperitoneal lymph node or spread via the lymphatic system of liver in patients with liver metastasis. Diagnosis of mediastinal lymph node metastasis is difficult. Inflammatory conditions in the mediastinum are important non-malignant cause of mediastinal lymph node enlargement on PET-scan. The ideal management strategy for mediastinal metastasis of CRC still remains a question, the two major options being local metastasectomy or systemic chemotherapy. CONCLUSIONS: Pleura and Mediastinal lymph nodes are rarely the first sites of recurrence for CRC. We reported a rare case of CRC recurrence that skipped the liver and lung and metastasized to the pleura and mediastinal lymph nodes. Clinicians must be aware of mediastinum as a potential site for metastasis during follow-ups of patients with CRC. Reference #1: Toda K, Kawada K, Sakai Y, Izumi H. Metachronous mediastinal lymph node metastasis from ascending colon cancer: A case report and literature review. Int J Surg Case Rep. 2017;41:336-339 Reference #2: El-Halabi MM, Chaaban SA, Meouchy J, Page S, Salyers WJ Jr. Colon cancer metastasis to mediastinal lymph nodes without liver or lung involvement: A case report. Oncol Lett. 2014 Nov;8(5):2221-2224. Reference #3: Matsuda Y, Yano M, Miyoshi N et al. Solitary mediastinal lymph node recurrence after curative resection of colon cancer. World J Gastrointest Surg. 2014 Aug 27;6(8):164-8. DISCLOSURES: No relevant relationships by shivika agarwal, source=Web Response No relevant relationships by Yusra Ansari, source=Web Response No relevant relationships by Rabih Maroun, source=Web Response No relevant relationships by Sami Pervaiz, source=Web Response No relevant relationships by Kartikeya Rajdev, source=Web Response No relevant relationships by Abdul Siddiqui, source=Web Response" @default.
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• W2894650824 date "2018-10-01" @default.
• W2894650824 modified "2023-09-25" @default.
• W2894650824 title "MEDIASTINAL RECURRENCE AFTER CURATIVE RESECTION OF COLON CANCER" @default.
• W2894650824 doi "https://doi.org/10.1016/j.chest.2018.08.449" @default.
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