IJCRR - Vol 07 Issue 03, February, 2015
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
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
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. Vol 07 Issue 03, February, 32-35
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