Unusual Spreading of Colon Adenocarcinoma into the Right Hip Area: A Case Report


Adenocarcinoma is the most common colon cancer type. This form of colonic neoplasms usually metastasizes initially to regional lymphatic system and through the blood circulation to the lungs and liver, while other forms of expansion and involvement of other organ systems are less common. Extraluminal carcinoma is very rare. Only a few authors describe the direct spread of cancer to adjacent structures and organs. In this paper we present a case of a 76-year old patient with tumor mass extending from the colon to the right hip area “per continuitatem”. The patient had no symptoms and signs that would indicate the presence of neoplastic process in the colon. Only a discomfort in right leg was present and finally tumor mass was visualized. Biopsy and patohistology findings confirmed final diagnosis and type of tumor in the right hip region. Pathohistologicaly tumor was adenocarcinoma.

Share and Cite:

R. Dintinjana, D. Petranović, G. Pilčič, V. Ilijic, D. Petranović and M. Dintinjana, "Unusual Spreading of Colon Adenocarcinoma into the Right Hip Area: A Case Report," Journal of Cancer Therapy, Vol. 3 No. 6A, 2012, pp. 985-988. doi: 10.4236/jct.2012.326126.

1. Introduction

In Western countries, cancer of the large intestine and rectum is the second most common type of cancer and the second leading cause of cancer death. Colorectal cancer it is the most common cause of cancer death among non-smokers. Factors associated with increased risk of colorectal cancer are host susceptibility and a sequence of different carcinogenic exposures. Although specific etiology for sporadic colorectal cancer is still elusive predisposing hereditary and environmental factors have been clearly identified [1].

Almost all colorectal cancers are adenocarcinomas, which develop from the lining of the colon and rectum. It usually begins on the surface of the intestinal or rectal lining or on a polyp. As the cancer grows, it begins to invade the wall of the intestine or rectum, and continuously spread to the nearby lymph nodes and perirectal fat tissue.  Also, it metastasizes by blood and lymph vessels mainly to the liver, or other sites [2]. Extraluminal carcinomas are very rare and they can produce unexpected manifestations of disease. Very few authors described local invasion with colorectal cancer to the nearby structures like invasion of inguinal structures [3,4].

2. Case Report

A 76-year old patient was admitted to the Department of Internal medicine, University Clinical Hospital Center Rijeka, due to progressive fatigue for the last two months.

At admission patient was afebrile, eupnoic, cardiorespiratory functions sufficient. There were no palpabile lymph nodes. Liver and spleen were not palpable. Her appetite was normal, had no weight loss, nausea and vomiting and did not noticed any changes in stool colour, frequency or consistency. She had no any abdominal discomfort or pain. Also urine and stool was normal.

Physical status was normal but she complained on slight discomfort in the right leg. The leg was practically normal, but when measured in hip area, circumference was 5 cm larger than the left leg.

Laboratory analysis were completely normal (Hemoglobin level was 12.5 g/dL, leukocytes 4.5, thrombocytes 238 × 10−9/L, with normal biochemical parameters including liver enzimes, protein electrophoresis, beta 2 microglobulin). There were no occult bleeding in the stool, and urine analyses were completely normal. We suspected paraneoplastic syndrome and performed mamography, gynecological exam, cardiology and pulmology consultation which were all normal.

As patient at admission complained on discomfort in the right leg we performed ultrasonography of the soft tissue and find soft tissue tumour infiltrate in the upper hip with no clear borders, in the region of quadriceps femoris more than 20 cm long.

Figure 1. Ultrasonography of the right hip. Infiltration with no clear borders in femoral region infiltrates musculus quadriceps femoris.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] R. Dobrila-Dintinjana, D. Trivanovic, M. Dintinjana, J. Vukelic and N. Vanis, “Effects of Dietary Counseling on Patients with Colorectal Cancer,” In: R. Etarh, Ed., Colorectal Cancer from Prevention to Patient Care, InTech, Rijeka, pp. 211-226.
[2] D. Mayers, “Colon Polyps and Cancer Risk,” 2007. http://coloncancer.about.com/od/screening/a/Polyps.htm
[3] P. W. Carne, J. N. Frye, A. Kennedy-Smith, J. Keating, A. Merrie, E. Dennett and F. A. Frizelle, “Local Invasion of the Bladder with Colorectal Cancers: Surgical Management and Patterns of Local Recurrence,” Disease of Colon Rectum, Vol. 47, No. 1, 2004, pp. 44-47. doi:10.1007/s10350-003-0011-z
[4] H Ueno, C Yamauchi, K Hase, T Ichikura and H. Mochizuki, “Clinicopathological Study of Intrapelvic Cancer Spread to the Iliac Area in Lower Rectal Adenocarcinoma by Serial Sectioning,” British Journal of Surgery, Vol. 86, No. 12, 1999, pp. 1532-1537. doi:10.1046/j.1365-2168.1999.01271.x
[5] M. Astin, T. Griffin, R. D. Neal, P. Rose and W. Hamilton, “The Diagnostic Value of Symptoms for Colorectal Cancer in Primary Care: A Systematic Review,” The British Journal of General Practice: The Journal of the Royal College of General Practitioners, Vol. 61, No. 586, 2011, pp. 231-243.
[6] P. Cervera and J. F. Fléjou, “Changing Pathology with Changing Drugs: Tumors of the Gastrointestinal Tract,” Pathobiology, Vol. 78, No. 2, 2011, pp. 76-89. doi:10.1159/000315535
[7] M. S. Cappell, “Pathophysiology, Clinical Presentation, and Management of Colon Cancer,” Gastroenterology Clinics of North America, Vol. 37, No. 1, 2008, pp. 1-24. doi:10.1016/j.gtc.2007.12.002
[8] A. P. Wimmer, J. P. Bouffard, P. R. Storms, J. A. Pilcher, C. Y. Liang and J. J. DeGuide, “Primary Colon Cancer without Gross Mucosal Tumor: Unusual Presentation of a Common Malignancy,” Southern Medical Journal, Vol. 91, No. 12, 1998, pp. 1173-1176. doi:10.1097/00007611-199812000-00017
[9] K. J. d’Silva, A. J. Dwivedi, A. Shetty and S. Prakash, “An Unusual Presentation of Colon Cancer in a Young Individual,” Digestive Diseases and Sciences, Vol. 50, No. 6, 2005, pp. 1033-1035. doi:10.1007/s10620-005-2699-1
[10] H. Wong, K. S. Law, P. Chan and T. Yau, “An Unusual Presentation of a Colon Cancer Patient Case Report,” Cancer Therapy, Vol. 6, 2008, pp. 783-786.
[11] E. W. Toh, B. Griffiths and M. Farooq, “An Atypical Presentation of Colorectal Cancer,” Journal of Surgical Case Reports, Vol. 1, 2012, p. 2.
[12] F. Fahrtash, D. Chan, A. Colebatch and J. Rutovitz, “A Very Unusual Presentation of Metastatic Colon Cancer,” ISRN Oncology, Vol. 2011, 2011, Article ID: 531803.
[13] L. K. Tumwine, M. Kagimu, P. Ocama, I. Segamwenge, N. Masiira-Mukasa, D. Wamala, O. Dworak and C. K. Opio, “Atypical Presentation of Colon Adenocarcinoma: A Case Report,” Journal of Medical Case Reports, Vol. 6, 2012, p. 58. doi:10.1186/1752-1947-6-58
[14] F. Cellini and V. Valentini, “Current Perspectives on Preoperative Integrated Treatments for Locally Advanced Rectal Cancer: A Review of Agreement and Controversies,” Oncology (Williston Park), Vol. 26, No. 8, 2012, pp. 730-735, 741.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.