title: Locally advanced colon cancer with cutaneous invasion: case report.
abstract: BACKGROUND
  Locally advanced colon cancer with direct abdominal wall and skin invasion is an extremely rare finding with most data being derived from case reports, historical autopsy-based or single-center retrospective studies. We present a unique case of a colon cancer with direct cutaneous invasion and colocutaneous fistulization.
  
  
  METHODS
  Eighty-six year old Caucasian female with multiple comorbidities, referred to Surgical Consultation due to ulcerated skin lesion in the abdomen. She had a long-standing large umbilical hernia but with no previous episodes of incarceration or occlusive symptoms. She denied any digestive or constitutional symptoms. Physical examination showed a large non-reducible umbilical hernia, with an associated painless firm mass within the hernia sac and cutaneous ulcerated growth. Colonoscopy revealed transverse colon cancer (endoscopic biopsy of the tumor and skin punch biopsy confirmed adenocarcinoma of the colon). Computed tomography showed a tumoral mass within the umbilical hernia, with cutaneous infiltration and enlarged regional lymph nodes. Rapid local progression led to colocutaneous fistula with total fecal diversion. We performed an extended right hemicolectomy with en bloc excision of the hernia sac and infiltrating cutaneous mass.
  
  
  CONCLUSIONS
  In the current era of widespread use of screening colonoscopies, initial diagnosis of locally advanced colon cancer is decreasing. However, this unique case presented an opportunity to recall the advantages of multivisceral resections.
authors.affiliation: Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal. ntalmeida@chtmad.min-saude.pt.
authors.forename: Nádia
authors.identifier: http://orcid.org/0000-0002-6869-0795
authors.initials: N
authors.lastname: Tenreiro
authors.affiliation: Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
authors.forename: Cátia
authors.initials: C
authors.lastname: Ferreira
authors.affiliation: Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
authors.forename: Silvia
authors.initials: S
authors.lastname: Silva
authors.affiliation: Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Marques
authors.affiliation: Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
authors.forename: Artur
authors.initials: A
authors.lastname: Ribeiro
authors.affiliation: Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
authors.forename: Paulo Jorge
authors.initials: PJ
authors.lastname: Sousa
authors.affiliation: Department of General Surgery, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
authors.forename: Fernando Próspero
authors.initials: FP
authors.lastname: Luís
mesh_terms: D034861:Abdominal Wall / Q000000981:diagnostic imaging / Q000473:pathology*; D000369:Aged, 80 and over; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology*; D003110:Colonic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D003113:Colonoscopy; D005260:Female; D006554:Hernia, Umbilical / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D009361:Neoplasm Invasiveness; D012867:Skin / Q000000981:diagnostic imaging / Q000473:pathology*; D015898:Tomography Scanners, X-Ray Computed
keywords: Case report; Colon cancer; Cutaneous invasion; Locally invasive