title: Favorable control of advanced colon adenocarcinoma with severe bone marrow metastasis: A case report.
abstract: Colorectal cancer (CRC) has a propensity to metastasize to the liver, lungs and regional abdominal lymph nodes, but rarely to the bone marrow. A 60-year-old man presented to the National Hospital Organization Kyushu Cancer Center with a 4-week history of persistent lower back pain, anorexia and difficulty defecating. Complete blood count revealed severe thrombocytopenia and erythroblastosis, suggesting a hematological malignancy. However, the bone marrow examination demonstrated involvement by a moderately to poorly differentiated adenocarcinoma, but no hematopoietic abnormalities. A computed tomography scan revealed thickening of the wall of the sigmoid colon, with para-aortic, hilar, mediastinal and supraclavicular lymphadenopathy. The patient was thus diagnosed with sigmoid colon adenocarcinoma with lymph node and bone marrow metastasis. Modified FOLFOX6 was promptly initiated, with concurrent therapy for disseminated intravascular coagulation (DIC). An increased number of thrombocytes was observed on day 6. After 3 cycles of treatment, the patient recovered from DIC and the levels of serum carcinoembryonic antigen and cytokeratin 19 fragment were decreased. Tumor biopsy during colonoscopy following recovery from DIC demonstrated poorly differentiated adenocarcinoma with mucin production, without mutations in theRAS,BRAForPIK3CAgenes, and a cytokeratin (CK) 7-negative, CK20-positive phenotype. The patient has been treated with chemotherapy for 150 days without disease progression. However, the efficacy of chemotherapy for rarely encountered bone marrow metastasis from CRC is poor. The present case was favorably maintained on chemotherapy and survived for 10 months.
authors.affiliation: Department of Medical Oncology, Fukuoka Wajiro Hospital, Fukuoka 811-021, Japan; Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan.
authors.forename: Fumiyasu
authors.initials: F
authors.lastname: Hanamura
authors.affiliation: Department of Medical Oncology, Fukuoka Wajiro Hospital, Fukuoka 811-021, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shibata
authors.affiliation: Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shirakawa
authors.affiliation: Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kuwayama
authors.affiliation: Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan; Department of Medical Oncology, Saiseikai Fukuoka General Hospital, Fukuoka 810-0001, Japan.
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Oda
authors.affiliation: Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka 812-8582, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ariyama
authors.affiliation: Department of Cancer Biology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Taguchi
authors.affiliation: Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan.
authors.forename: Taito
authors.initials: T
authors.lastname: Esaki
authors.affiliation: Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors.forename: Eishi
authors.initials: E
authors.lastname: Baba
keywords: bone marrow metastasis; chemotherapy; colon cancer; disseminated intravascular coagulation