Unusual Spreading of Colon Adenocarcinoma into the Right Hip Area: A Case Report ()
1. Introduction
In Western countries, cancer of the large intestine and rectum is the second most common type of cancer and the second leading cause of cancer death. Colorectal cancer it is the most common cause of cancer death among non-smokers. Factors associated with increased risk of colorectal cancer are host susceptibility and a sequence of different carcinogenic exposures. Although specific etiology for sporadic colorectal cancer is still elusive predisposing hereditary and environmental factors have been clearly identified [1].
Almost all colorectal cancers are adenocarcinomas, which develop from the lining of the colon and rectum. It usually begins on the surface of the intestinal or rectal lining or on a polyp. As the cancer grows, it begins to invade the wall of the intestine or rectum, and continuously spread to the nearby lymph nodes and perirectal fat tissue. Also, it metastasizes by blood and lymph vessels mainly to the liver, or other sites [2]. Extraluminal carcinomas are very rare and they can produce unexpected manifestations of disease. Very few authors described local invasion with colorectal cancer to the nearby structures like invasion of inguinal structures [3,4].
2. Case Report
A 76-year old patient was admitted to the Department of Internal medicine, University Clinical Hospital Center Rijeka, due to progressive fatigue for the last two months.
At admission patient was afebrile, eupnoic, cardiorespiratory functions sufficient. There were no palpabile lymph nodes. Liver and spleen were not palpable. Her appetite was normal, had no weight loss, nausea and vomiting and did not noticed any changes in stool colour, frequency or consistency. She had no any abdominal discomfort or pain. Also urine and stool was normal.
Physical status was normal but she complained on slight discomfort in the right leg. The leg was practically normal, but when measured in hip area, circumference was 5 cm larger than the left leg.
Laboratory analysis were completely normal (Hemoglobin level was 12.5 g/dL, leukocytes 4.5, thrombocytes 238 × 10−9/L, with normal biochemical parameters including liver enzimes, protein electrophoresis, beta 2 microglobulin). There were no occult bleeding in the stool, and urine analyses were completely normal. We suspected paraneoplastic syndrome and performed mamography, gynecological exam, cardiology and pulmology consultation which were all normal.
As patient at admission complained on discomfort in the right leg we performed ultrasonography of the soft tissue and find soft tissue tumour infiltrate in the upper hip with no clear borders, in the region of quadriceps femoris more than 20 cm long.
Figure 1. Ultrasonography of the right hip. Infiltration with no clear borders in femoral region infiltrates musculus quadriceps femoris.