Emergent CT was performed and demonstrated a large abdominal wall abscess of 15 × 12 cm in size, which contained a moderate amount of air (Fig. Serum CEA (normal range 0–5 ng/ml) and CA19-9 (normal range 0–37 U/ml) were 1.2 ng/ml and less than 2 U/ml, respectively. Laboratory data were otherwise nonspecific except for mild dehydration. The white blood cell count was 19,000/m 3 and CRP, 46.04 mg/dl. ![]() The skin of the right lower abdominal wall, 8 × 3 cm in size, was black and associated with fluctuation and tenderness, indicating an abdominal wall abscess complicated by skin necrosis. Physical examination revealed a body temperature of 37.8 ☌, blood pressure of 106/70 mmHg, and heart rate of 129 beats/min. ![]() Her medical history included surgeries for dislocations of the hip joint. Then, gradually, the skin color of the right lower quadrant of the abdomen darkened with deterioration of her general condition. Two weeks before presentation, the patient noticed abdominal pain and fever accompanied with a loss of appetite. Therefore, the authors advocate that patients with axillary lymph node metastasis should be evaluated with regard to the possibility of surgical curability.Ī 76-year-old woman presented with abdominal pain, fever, and a color change in the skin of the abdominal wall. If axillary lymph node metastasis results from aberrant lymphatics due to invasion from an adjacent organ, and not the result of systemic malignant disease, it may be considered as a surgically curable pathology. This is the first case report of axillary lymph node metastasis of carcinoma of the cecum with histologically proven invasion via the lymphatic system in the skin. Two months later, an enlarged right axillary lymph node was noticed on CT, and an excisional biopsy was obtained, which later confirmed metastatic adenocarcinoma. ![]() Histology demonstrated multiple sites of lymphatic invasion in the skin. A 76-year-old woman with cecal carcinoma (T4N1M0), complicated with an abdominal wall abscess, underwent right hemicolectomy with partial resection of the abdominal wall. Here, we present a case with axillary lymph node metastasis of cecal carcinoma associated with macroscopic invasion of the skin of the abdominal wall with histological evidence of such invasion, findings which support our hypothesis that the axillary lymph node metastasis developed via the lymph channels in the skin of the abdominal wall. Axillary lymph node metastasis from colorectal carcinoma is extremely rare, and this scarcity hinders understanding of its pathogenesis and, thus, the application of appropriate management.
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