IJCRR - 7(3), February, 2015
Pages: 32-35
A RARE PRESENTATION OF CARCINOMA ANAL CANAL PRESENTING WITH DISTANT AXILLARY LYMPH NODE METASTASIS
Author: P. Ravindra Kumar, Siva Sankar Kotne, P. B. Ananda Rao, Surendra
Category: Healthcare
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Abstract:
Introduction: Anal carcinomas present as a locoregional disease with regional lymph node metastases. Distant vascular metastasis to liver, lung , etc. is less than 10% and distant lymphatic spread to supraclavicular, paraaortic or mediastinal lymph nodes is less than 1%. Axillary lymph node metastasis is extremely unusual in anal carcinomas and we couldn’t find any literature review.
Case Report: Here we report a 34 years old female who was diagnosed to have moderately differentiated squamous cell carcinoma of anal canal with bilateral inguinal lymph nodes. Regular general examination revealed a left axillary lymph node which on cytology showed squamous cell carcinomatous deposits. Possibility of lymphoma, second primary and contiguous lymphatic spread was ruled out on thorough examination and investigations.
Treatment Policy: In view of unusual rare presentation of carcinoma anal canal with distant solitary lymph node metastasis, the case is staged as stage IV disease. We planned as a case based planning and started with chemotherapy (neoadjuvant) followed by concurrent chemo radiotherapy and then by surgery if essential. Patient presently had good response after two cycles of neoadjuvant chemotherapy.
Conclusion: In conclusion, although local lymph nodes in anal carcinomas are common and initial sites of spread, distant metastasis to axillary lymph node is unlikely without involvement of para aortic or mediastinal or supraclavicular lymph nodes. Hence, this case is an unusual presentation of carcinoma anal canal with skipped lymph node metastasis.
Keywords: Anal carcinoma, Metastatic axillary lymph node, Squamous cell carcinoma
Citation:
P. Ravindra Kumar, Siva Sankar Kotne, P. B. Ananda Rao, Surendra. A RARE PRESENTATION OF CARCINOMA ANAL CANAL PRESENTING WITH DISTANT AXILLARY LYMPH NODE METASTASIS International Journal of Current Research and Review. 7(3), February, 32-35
References:
1. American Joint Committee on Cancer. AJCC cancer staging handbook. Philadelphia: Lippincott-Williams & Wilkins.
2. International Union Against Cancer. UICC TNM atlas. 7th ed. Berlin: Springer, 2010.
3. BRUCE M. BOMAN, MD, CHARLES G. MOERTEL,et al. Carcinoma of the Anal Canal A Clinical and Pathologic Study of 188 Cases Cancer 54:114-125, 1984.
4. James V. Klas, M.D.et.alMalignant Tumors of the Anal Canal The Spectrum of Disease, Treatment, and OutcomesCancer 1999;85:1686–93. © 1999 American Cancer Society.
5. Attili VSS, Rama Chandra C*, Dadhich HK, Sahoo TP, Anupama G, Bapsy PP Unusual metastasis in colorectal cancer www.indianjcancer.com/ April–June 2006 | Volume 43 | Issue 2.
6. Lookingbill DP, Spauler N, Helm KF. Cutaneous metastases in patients with metastatic carcinoma: A retrospective analysis of 4020 patients. J Am Acad Dermat 1993:29:228- 36.
7. Cortese AF. Surgical approach for treatment of epidermoid anal carcinoma. Cuncer 1975: 36: 1869- 1875.
8. Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal canal: A preliminary report. Dis Colon Recritm 1974; 3:354.
9. NORMAN D. NIGRO MD,* H. GUNTER SEYDEL, MD,et.al Combined Preoperative Radiation and Chemotherapy for Squamous Cell Carcinoma of the Anal CanalCancer 51 : 1826-1829, 1983.
10. Arthur Hung, M.D.,et.al.Cisplatin-Based Combined Modality Therapy for Anal Carcinoma A Wider Therapeutic IndexCancer 2003;97:1195–202.© 2003 American Cancer Society.
11. Robert Glynne-Jones, MD, et,al; for the United Kingdom Coordinating Committee on Cancer Research Anal Cancer Trial Working PartyPrognostic Factors for Recurrence and Survival in Anal CancerCancer 2013;119:748-55. VC 2012 American Cancer Society
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