Cancer Res Treat.  2004 Apr;36(2):157-159.

Isolated Diaphragmatic Metastasis Originated from Adenocarcinoma of the Colon

• Lee KH
• Yu CS
• Namgung H
• Kim HC
• Kim JC

Abstract

Isolated diaphragmatic metastasis arising from colorectal cancer has been reported only one case in the literature presently. Here, we presented a new case and discussed the possible pathogenesis and the treatment options. A 42-year-old male patient had received anterior resection for sigmoid colon cancer. Although the increased serum CEA level was detected 20 months after the surgery, metastatic lesion could not be detected by repeated colonoscopy, CT scan, bone scan or PET scan for 35 months. We could detect a suspicious metastatic lesion on the liver by CT scan at 56 month after the surgery. During a second-look operation, we found a solitary metastasis on the diaphragm and removed it along with the 1 cm tumor-free resection margin. Although the prognosis associated with skeletal metastasis is poor, the complete resection of isolated diaphragmatic metastasis and subsequent appropriate adjuvant chemotherapy may achieve a cure the disease provided that other metastatic lesions are absent.

Keyword

Colorectal neoplasm; Metastasis; Diaphragm; Carcinoembryonic antigen

MeSH Terms

Adenocarcinoma*
Adult
Carcinoembryonic Antigen
Chemotherapy, Adjuvant
Colon*
Colonoscopy
Colorectal Neoplasms
Diaphragm
Humans
Liver
Male
Neoplasm Metastasis*
Positron-Emission Tomography
Prognosis
Sigmoid Neoplasms
Tomography, X-Ray Computed
Carcinoembryonic Antigen

Figure

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  Fig. 1 Clinical course of the patient: the close correlation between serum CEA level and treatment response.

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  Fig. 2 MRI of an isolated metastatic tumor on the diaphragm. (A) Gadolinium enhanced T1-weighted axial view showed a ill-defined peripherally enhanced low signal lesion (arrow). (B) coronal view showed a protruding mass with motion artifact (arrow).

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  Fig. 3 Histopathological findings. (A) primary sigmoid colon cancer (H&E, ×200). (B-C) isolated metastasis on the diaphragm. The metastatic tumor, which involved entire thickness of the diaphragm, had a moderate cellular differentiation and amount of mucin similar to that of the primary sigmoid colon cancer (H&E, ×200, ×40).

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