Work

Metastasis of Rectal Adenocarcinoma Mimicking Hpv Lesions

Year: 2024

Type: article

Abstract: Case Presentation A 71-year-old male presented to the coloproctology outpatient clinic of a tertiary hospital after being referred from the emergency department due to an anoperineal abscess and suspected genital lesions from Human Papillomavirus (HPV). He complained of painful perianal protrusion, bleeding during bowel movements for one year, weight loss of 12 kg over the same period, as well as scrotal warts and painless inguinal nodules. His medical history included an anoperineal fistula for 30 years, requiring two surgeries. Undergoing oncological investigation in an external service, a colonoscopy revealed an ulcerovegetative lesion in the rectosigmoid, occupying 80% of the lumen, and histopathology confirmed adenocarcinoma. On proctological examination, multiple verrucous, infiltrative lesions with central ulceration were observed on the scrotum, perineum, and right groin, in addition to bilaterally enlarged, fibroelastic inguinal lymph nodes. A retoscopy showed normal mucosa up to 12 cm from the anal margin, where a polypoid, infiltrative lesion with friable, bleeding tissue was observed, occupying 50% of the rectal lumen up to 16 cm from the anal margin. Additional exams indicated infiltration of the mesorectal fat, pelvic wall, and right spermatic vein. Histopathology of the verrucous lesions confirmed adenocarcinoma. Given the presence of high rectal tumor metastasis to the skin, an initial plan for resection and Hartmann colostomy, followed by systemic chemotherapy, was proposed. However, after discussing the palliative nature of the surgery due to the cutaneous metastasis, the patient and family opted for palliative chemotherapy. Discussion Cutaneous metastasis of colorectal adenocarcinoma is rare, with the abdominal wall being the most common site. It occurs through hematogenous and lymphatic dissemination and usually manifests late after the surgical resection of the primary tumor. The prognosis is poor, and the average survival for patients after the appearance of cutaneous lesions ranges from 3 to 18 months. Conclusion This case aims to discuss possible differential diagnoses for cutaneous metastases from colorectal adenocarcinomas. A high level of clinical suspicion is required for diagnosing metastatic skin lesions, as when present, cutaneous metastasis is a standalone poor prognostic factor for oncology. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Source: Journal of Coloproctology

DOI: 10.1055/s-0045-1808665