Patient underwent core biopsy of the right 5-Fluoracil supplier inguinal node by an interventional radiologist. Final pathology revealed a follicular non-Hodgkin’s lymphoma, CD20 positive, as a second primary malignancy. Upon completion of further workup, patient was found to have synchronous diagnoses of a stage II non-Hodgkin’s lymphoma and a cT3 N0 M0 proximal rectal adenocarcinoma with moderate obstruction. The rectal adenocarcinoma was treated as a localized disease with plan for definitive resection. Treatment plan was therefore prioritized to the symptomatic
rectal cancer, and the treatment plan for the lymphoma to follow. Treatment for the rectal cancer consisted of neoadjuvant chemoradiation with plan for low Inhibitors,research,lifescience,medical anterior resection as the definitive surgery. Patient tolerated the treatment well. Figure 1 Index rectal adenocarcinoma Figure 2 Right inguinal adenopathy Figure 3 Retroperitoneal adenopathy Discussion Primary treatment of rectal cancer is definitive resection
in conjunction with neoadjuvant or postoperative multimodality therapy as indicated. Common regional Inhibitors,research,lifescience,medical nodes for rectal and rectosigmoid cancer include peri-rectal, left colic, sigmoid mesenteric, inferior mesenteric, presacral, internal iliac, superior-middle-inferior hemorrhoidal, lateral sacral and sacral promontory regions. Involvement of external iliac and inguinal nodal regions are Inhibitors,research,lifescience,medical rare. Therefore, these regions are not typically included in radiation Inhibitors,research,lifescience,medical field design. Exceptions are made for T4 tumors involving anterior structures. Inclusion of the inguinal nodes for tumors invading into the distal anal cancer should also be considered (3). For patients with true metastatic disease to inguinal regions, their prognosis could be poor with median survival of about 12 months in previous retrospective studies (4,5). In cases of stage IV disease, local control of the disease
and use of surgery will depend on the general health Inhibitors,research,lifescience,medical of the patient as well as clinical symptoms and response to induction chemotherapy. If a patient is deemed to have a stage IV disease, systemic chemotherapy will generally be used for disease control. Surgery and/or radiation would be reserved for symptomatic control in such cases. Should this patient have been deemed stage IV, he would have missed the opportunity for optimal local control without a chance for definitive treatment. By further defining the disease stage Thymidine kinase of patient’s rectal cancer by defining the histology of the inguinal lymph node, we were able to identify the lymphoma as a second primary malignancy. Therefore, definitive treatment plans were applied for optimal control of both cancers in this healthy gentleman. Acknowledgements Disclosure: The authors declare no conflict of interest.
A literature search was conducted using Pubmed and Embase electronic databases. The following MESH terms were used for disease location: “rectum” “anus”, “perianal”.
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