title: Right axillary lymph node metastasis of carcinoma of the cecum with histologically proven cutaneous lymphatic invasion by carcinoma cells: a case report.
abstract: Axillary lymph node metastasis from colorectal carcinoma is extremely rare, and this scarcity hinders understanding of its pathogenesis and, thus, the application of appropriate management. Here, we present a case with axillary lymph node metastasis of cecal carcinoma associated with macroscopic invasion of the skin of the abdominal wall with histological evidence of such invasion, findings which support our hypothesis that the axillary lymph node metastasis developed via the lymph channels in the skin of the abdominal wall. A 76-year-old woman with cecal carcinoma (T4N1M0), complicated with an abdominal wall abscess, underwent right hemicolectomy with partial resection of the abdominal wall. Histology demonstrated multiple sites of lymphatic invasion in the skin. Two months later, an enlarged right axillary lymph node was noticed on CT, and an excisional biopsy was obtained, which later confirmed metastatic adenocarcinoma. This is the first case report of axillary lymph node metastasis of carcinoma of the cecum with histologically proven invasion via the lymphatic system in the skin. If axillary lymph node metastasis results from aberrant lymphatics due to invasion from an adjacent organ, and not the result of systemic malignant disease, it may be considered as a surgically curable pathology. Therefore, the authors advocate that patients with axillary lymph node metastasis should be evaluated with regard to the possibility of surgical curability.
authors.affiliation: Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Yutaka J
authors.initials: YJ
authors.lastname: Kawamura
authors.affiliation: Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Michitaka
authors.initials: M
authors.lastname: Kohno
authors.affiliation: Department of Pathology, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Shiga
authors.affiliation: Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Asakage
authors.affiliation: Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Hatano
authors.affiliation: Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Okame
authors.affiliation: Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Sasaki
authors.affiliation: Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Tobari
authors.affiliation: Department of Surgery, Tsudanuma Central General Hospital, 1-9-17 Yatsu, Narashino-shi, Chiba 275-0026 Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Nishida
keywords: Axillary lymph node metastasis; Colorectal carcinoma; Lymphatic invasion