PICTURES IN DIGESTIVE PATHOLOGY

 

Adenocarcinoma at the site of a terminal colostomy. A rare but important entity

Adenocarcinoma sobre colostomía terminal. Una entidad rara pero relevante

 

 

Manel Cremades-Pérez, Miquel Gómez-Artacho, Jordi Navinés and Jaime Fernández-Llamazares-Rodríguez

Division of General and Gastrointestinal Surgery. Hospital Germans Trias i Pujol. Badalona, Barcelona. Spain

 

 

Introduction

Colon and rectum cancer is the second most prevalent neoplasia in Spain, affecting 49 cases per 100.000 habitants. Fifteen percent also carry colostomy, which can favor oncologic free margins and endoscopic follow up. Nevertheless, the appearance of a new neoplasia at the colostomy site is not to be neglected, since 15 cases have already been described in the literature (1).

 

Clinical case

A 60-year-old woman had been through Miles abdomino-perineal resection due to neoplasia of the rectum, transverse segmentary resection for colon neoplasia and right hemicolectomy for caecal adenoma at the age of 31, 35 and 53 respectively.

After 5 years, at a routine colonoscopy, two polypoid formations were identified and resected being the rest of the exploration normal.

At the following visit an exophytic, granulomatous, irregular and painless lesion was detected in the colostomy margin (Figs. 1 and 2). The biopsy revealed an intramucous adenocarcinoma with focal submucous infiltration. The patient had a resection of the previous stoma and a new terminal colostomy was performed, without the administration of adjuvant chemotherapy. After a 2 year-follow up the patient is free from disease.

 

 

Discussion

Metachronic colorectal neoplasias represent three percent of all cases (2), lying exceptionally at the colostomy level (3,4). However, benign injuries as granulomas or irritative ulcers are quite frequent.

A proper exploration and biopsy of the suspicious stomal injuries should be performed systematically.

The treatment for this pathology is based on a free-margin surgery. Nevertheless, regarding its low incidence, there are no studies on the need to add adjuvant chemotherapy (5).

 

References

1. Mourra N, Bataillon G, Lesurtel M. Fungating mass occurring at a colostomy site 50 years after colectomy for inflammatory condition. Gastroenterology 2014;146:e1-e2.         [ Links ]

2. Wild JR, Garner JP, Skinner PP. Adenocarcinoma of a colostomy following abdominoperineal resection for squamous cell carcinoma of the anal canal: A case study. Ostomy Wound Manage 2011;57:38-40.         [ Links ]

3. Sabater-Marco V, García-García JA, Roig-Vila JV. Basaloid large cell lung carcinoma presenting as cutaneous metastasis at the colostomy site after abdominoperineal resection for rectal carcinoma. J Cutan Pathol 2013;40:758-64.         [ Links ]

4. Kuo YH1, Chin CC, Lee KF. Metastasis at the colostomy site: A rare case report. Jpn J Clin Oncol 2012;42:753-6.         [ Links ]

5. Chintamani, Singhal V, Bansal A, et al. Isolated colostomy site recurrence in rectal cancer-two cases with review of literature. World J Surg Oncol 2007;5:52-6.         [ Links ]