title: [Extracolonic manifestation as first sign of colorectal carcinoma. Report of 2 cases].
abstract: BACKGROUND
  In Mexico, colorectal cancer is the second most common malignant tumor of digestive tract; incidence is proportional to patient age. At time of diagnosis, 20% of patients can be found with metastases, liver and lung the organs affected most frequently.
  
  
  OBJECTIVE
  To present two young patients, whose primary complaints were atypical extracolonic symptoms of colorectal cancer.
  
  
  METHODS
  CASE 1: A 44-year-old female who presented with left pleural effusion, with growth in culture positive for enterobacterias. Barium enema showed tumor in splenic flexure. Surgical resection was performed including, left kidney, spleen, tail of pancreas, and fourth portion of duodenum. Colo-pleural fistula was repaired with primary closure. The pathology report noted locally advanced adenocarcinoma of colon (T4 N0 M0). CASE 2: A 22-year-old female, who presented with a 30 day history of neurologic complaints. Computer tomography of head and MRI of brain identified a mass at level of cerebellum; specimen biopsy report was consistent with metastasis adenocarcinoma. Colonoscopy found a tumor located 12 cm from anal verge. The patient underwent sigmoid resection. Pathology confirmed the presence of moderately differentiated adenocarcinoma and 14/22 positive nodes (T3, N2, M1).
  
  
  CONCLUSIONS
  The most common sites of metastases secondary to colorectal cancer are liver and lung, up to 30% at diagnosis, and usually are asymptomatic. We reported two patients whose first evidence of disease were atypical symptoms related to unusual sites of colorectal cancer extension.
authors.affiliation: Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Hinojosa
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Plata-Muñoz
authors.forename: Heriberto
authors.initials: H
authors.lastname: Medina
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takahashi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary*; D000328:Adult; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans