Isolated abdominal wound recurrence after lymph-node dissection for appendiceal adenocarcinoma.
A 47-year-old man with acute abdominal pain in the right lower quadrant underwent an appendectomy via McBurney's incision. Postoperative histology revealed a moderately differentiated adenocarcinoma in the appendix that invaded the submucosa along with lymphatic involvement. Forty-three days later, an ileocecal resection with radical lymph node dissection was performed through a midline incision. Three of the 30 resected lymph nodes were found to have adenocarcinoma metastasis. Five years later, an isolated abdominal wall recurrence occurred within the wound scar of the midline incision. A complete excision of the tumor and the invaded portion of the ileum was performed. To date, the patient has been well, with no evidence of recurrence for 5 years since the resection. The mechanism of abdominal wound recurrence is considered the leakage of carcinoma cells from transected lymph vessels during lymph node dissection, followed by the implantation of these cells into the abdominal wound.
Yamaguchi
Hironori
H
Department of Surgical Oncology, University of Tokyo Hospital, Tokyo, Japan. yamaguchih-tky@umin.net
Ishimaru
Masahiro
M
Suzuki
Hiroyuki
H
Yamashita
Hiroharu
H
Hatanaka
Kazuhito
K
Uekusa
Toshimasa
T
Nagawa
Hirokazu
H
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D034861:Abdominal Wall / Q000473:pathology*; D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D001062:Appendectomy / Q000379:methods; D001063:Appendiceal Neoplasms / Q000473:pathology / Q000601:surgery*; D002921:Cicatrix / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D012086:Reoperation; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome