title: Solitary left axillary lymph node metastasis after curative resection of carcinoma at the colostomy site: a case report.
abstract: BACKGROUND
  The incidence of axillary lymph node metastasis (ALNM) of colon cancer is very low, and there have been only a few reports of solitary ALNM. Neither the mechanism involved in solitary colon cancer ALNM nor the proper treatment has been elucidated. We encountered a case of solitary left ALNM after curative resection of carcinoma at the colostomy site.
  
  
  METHODS
  A 53-year-old man underwent a Hartmann's operation for Hirschsprung disease during his adolescence. He complained of a mass of the descending colon and was diagnosed with colon cancer at the colostomy site with pagetoid spread to the adjacent skin. The cancer at the stoma site was resected, and a transverse colostomy was performed. Nine years later, his carbohydrate antigen (CA) 19-9 level was high during a health screening. On physical examination, adenopathy was palpated in the left axilla. Computed tomography (CT) demonstrated a lymph node in the left axillary fossa that was 33 mm in diameter, and (18)F-fluorodeoxyglucose positron emission tomography/CT showed high uptake in the lesion. We performed a curative resection of the left axillary lymph node. The lesion was pathologically diagnosed as left ALNM originating from the adenocarcinoma at the colostomy site. After lymph node resection, his serum CA19-9 level decreased compared to that observed at baseline. He has been receiving adjuvant chemotherapy (capecitabine plus oxaliplatin) without recurrence for 5 months after lymph node resection.
  
  
  CONCLUSIONS
  The present case report shows that carcinoma at the colostomy site with pagetoid spread can metastasize to the axillary lymph nodes through superficial abdominal lymphatic pathways, and surgical resection followed by adjuvant chemotherapy may be a potent strategy to treat solitary colon cancer ALNM.
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Imaizumi
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. homma.s@nifty.com.
authors.forename: Shigenori
authors.initials: S
authors.lastname: Homma
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Shimokuni
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Sakihama
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.|Surgical Center, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawamura
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Takakuwa
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
keywords: Adjuvant chemotherapy; Axillary lymph node metastasis; Colon cancer; Colostomy site; Pagetoid spread