Ten Year History of Colorectal Secondary Tumors: Hpital St-Antoine, and Gustave-Roussy Institut Experience
N Mourra, C Shields, L Arrive, E Tiret, J-F Flejou, P Duvillard. Hopital St-Antoine, Paris, France; Gustave-Roussy, Villejuif, France
Background: Unlike the small bowel, where secondary tumors are as common as the primary ones, the colorectal mucosa is seldom the site of metastatic disease. Metastases from breast or lung carcinomas are the most common in females, whereas gastrointestinal tract and lung tumors are the most common source of metastatic lesions in males. We report here 22 cases of truly colorectal metastases from two institutions, widely involved in the treatment of colorectal tumors, during the last decade.
Design: During the last decade, 4912 patients underwent colorectal surgery for malignant tumors, of which 87 for secondary tumors. Sixty five cases were excluded, either because the involvement of colon and rectum was by direct invasion from neighbouring tumors, or because we could not rule out the extension from pertioneal or pelvic seeding, even after a long follow-up (stomach:5 cases, pancreas:1, ovary:25, uterus, including cervix and vagina: 26, prostate:2, urinary bladder:4, and tube:2). Only 22 cases (3 men; mean age, 59 years) were included. The mean disease free intreval was 6 years (range:1month-18years). At the time of follow-up, 17 patients died from disease, with a mean survival time of 9 months (range:1-21 months). Only one patient is still alive (6 months) and the remaining 4 were lost to follow-up.
Results: The patients presented with obstruction, bleeding or abdominal pain. The sources of metastases were : breast (11 cases), Melanoma (6: 1 Choroid, 1 Anus, and 4 skin ), Sarcoma (3: 1 osteosarcoma, 2 leyomyosarcoma), pancreas (1), and kidney (1). The metastases were located in the right colon (8 cases), left colon (8), transverse colon (4), rectum (1), diffuse (1). Grossly, the most common feature was polypoid lesion, nodule, ulceration or diffuse thickening wall were less common. Microscopic faetures were almost similar to the primary tumors. Immunohistochemistry were performed on the biopsy specimen, mainly for breast metastases, and melanoma.
Conclusions: Truly colorectal metastases are exceptional, they represent only 0.002% of colorectal tumors in our series.They reflect a poor prognosis and any therapy is usually palliative. Therefore, the pathologist should be alert for the possibility of secondary tumors when studying large bowel biopsies, in which the appearences of the tumor are unusual or unlike ordinary colorectal cancer.
Monday, March 9, 2009 1:00 PM
Poster Session II # 85, Monday Afternoon