Peristomal adenocarcinoma 16 years after colorectal adenocarcinoma resection with curative intent

Abstract

Metachronous colorectal cancer is relatively rare, occurring in 0.7-3.6% of patients diagnosed with colorectal adenocarcinoma. Cutaneous metastases are similarly a rare presentation, occurring in <6% of metastatic colorectal cancer patients. Even more rare are the cutaneous recurrences at the peristomal site. Clinically, it is difficult to distinguish between metachronous cancer and cutaneous metastases. This paper reports a case of an elderly woman presenting with a slowly progressing peristomal cutaneous lesion 16 years after surgical resection for colorectal cancer. Core punch biopsy revealed a cutaneous localization of an intestinal type of adenocarcinoma. A surgical resection of the peristomal area was carried out whereby a new colostomy was created on the contralateral side. Definite histopathological examination showed a superficially located intestinal type adenocarcinoma with extensive pagetoid spread in the epidermal surface. In conclusion, it is important to remain alert and strive for early detection for cutaneous abnormalities following colorectal cancer.

Figure 1

Peristomal skin abnormality.

Figure 2

PET/CT scan showing minimal FDG stacking at the colostomy site.

Figure 3

Intra-operative view: (a) resection of the peristomal area; (b) removal of the previous colostomy; (c) the defect including open fascia; (d) side-to-side resected area and the remaining defect.

Figure 4

Histopathological examination showing the gross specimen and microscopic pictures; the H&E staining shows the superficial intestinal type adenocarcinoma with intra-epithelial pagetoid extension; the CDX2 staining accentuates the intestinal differentiation with pagetoid extension; the P53 staining highlights the neoplastic nature of this (intra-epithelial) lesion.