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Isolated cervical metastasis of colon cancer

Colorectal cancer (CRC) is the third most common cancer worldwide. About half of all CRC patients develop distant metastases. CRC is spread via the lymphatic and haematogenous routes and is well known to metastasize to the liver and lungs, among other reported sites (e.g. the abdominal cavity, ovaries, adrenal glands, bones and brain). Atypical metastases of CRC cases have been reported in small case series and case reports. This article presents an unusual case of isolated cervical metastasis of colon cancer. To the best of our knowledge, there is no similar report described in the literature. Seven years ago, a 62-year-old patient underwent sigmoidectomy because of an obstructive tumour. The histopathological analysis showed stage III mucinous adenocarcinoma. The patient was referred for adjuvant FOLFOX treatment. In the last 3 years, this patient presented two local recurrences, neither of which showed the presence of systemic metastases. In both relapses, the patient was submitted to an R0 resection and received a FOLFIRI-bevacizumab chemotherapy regime. Figure 1 shows the positron emission tomography/computed tomography scanner images collected during the two episodes of local recurrence. About 6 months after the last operation, the patient started complaining of oropharyngeal pain. Physical examination revealed a tumour in the cervical region. A cervical computed tomography scan showed a mass in the right submandibular region (Fig. 2). The patient underwent an exploratory cervicotomy and an irressecable tumour affecting area IA bilaterally and IB on the right was noted. The histopathological and immunohistochemistry analyses of the cervical lesions showed a mucinous adenocarcinoma, similar to colon carcinoma, with high microsatellite instability (Fig. 3). The patient was referred for chemotherapy with pembrolizumab; however, the patient died about 3 months after the start of chemotherapy due to complications from the disease.