A 55-year-old male, with no relevant past medical history, was studied due to altered intestinal rhythm and rectal bleeding. After endoscopy and biopsy, he was diagnosed with a well-differentiated, mucinous, clinical N2 magnetic resonance (M0) adenocarcinoma.
The patient was initially treated with neoadjuvant radiochemotherapy; long-cycle radiotherapy with a total dose of 50.4 Gy for 5 weeks, and oral capecitabine at a rate of 825 mg/1250 mg/m.
Eight weeks after the end of treatment, an extended perineal amputation was performed.
The anatomopathological result of the surgical specimen was mucinous adenocarcinoma of the rectum, 4.5 cm from the anal margin, whose total ganglion exceeded 2 mm from the muscularis propria, with surgical edges proximal and distal to the circular adenopathy 10 mm.
Mesorectal excision (in the mesorectal plane) and anal canal (in the elevator plane) were satisfactory (ypT3bN1).
The patient's postoperative course was uneventful and subsequently received 6 cycles of oral capecitabine chemotherapy at a rate of 2,000 mg/12h every 21 days.
Ongoing surgery was controlled by the local emergency department with normal CT findings and tumor markers one year after surgery.
In his routine review 18 months after surgery, the patient reported the progressive appearance of subcutaneous facial nodules in the frontal zone, left axilla, right pectoral, left flank and lower extremities.
Physical examination corroborated the existence of subcutaneous nodules measuring between 0.5 and 1 cm in the locations described, with elastic consistency and rounding.
A CT scan of the abdomen showed multiple images suggestive of liver and lung metastases, as well as subcutaneous lesions located in the right pectoral area left axillary area, anterior abdominal wall, left flank.
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Exeresis-biopsy was performed in one of the subcutaneous nodules located in the right pectoral region with anatomopathological result of subcutaneous metastasis of well differentiated rectal adenocarcinoma.
Diagnosis of disseminated tumor recurrence was evaluated again chemotherapy treatment that the patient did not receive due to the rapid deterioration of his general condition that led to his death.
