Rectal Cancer: Asynchronous Metastasis to the Temporal Bone, Temporomandibular Joint and Middle Ear

Author Info

Aiva Mahmood Ali Mahmood Nasrullah Manji

Corresponding Author

Ali Mahmood
Assistant Professor of Clinical Surgery, Institute of Academic Medicine, Houston Methodist Hospitals System, Texas, USA

A B S T R A C T

Rectal cancer has the potential to metastasize to multiple anatomical sites. The hallmark of treatment presides with sound oncologic surgery, adjunct with chemotherapy and radiation therapy when indicated. The initial presentation determines the management regimen, consisting of physical examination and diagnostic imaging. A 54-year-old female presented with locally advanced rectal cancer. Upon conclusion of neoadjuvant chemotherapy and radiation therapy, she underwent a low anterior resection with total mesorectal excision. Her surgical margins were negative; however, of the 21 lymph nodes retrieved, 11 were positive for cancer. The patient underwent further adjuvant chemotherapy. 2 years, 8 months later, the patient presented to the emergency department with worsening swelling of the right side of the face, with increasing pain, hearing, and visual impairments. Diagnostic imaging revealed a large lesion in the cranial anatomy, invading the temporal bone, temporomandibular joint, sphenoid bone and anterior superior epitympanum of the right middle ear. The patient underwent operative intervention followed by radiation and chemotherapy. Asynchronous metastasis of rectal cancer to the cranium is a rare finding and an invasion into the temporal bone even more scarcely reported. The prognosis for distant metastatic disease is poor because it involves metastatic spread via the lymph channels or vascular system. Patients that have undergone treatment for advanced rectal cancer must be approached with a high index of suspicion for distant metastatic disease, even in the advent of routine negative surveillance

Article Info

Article Type

Case Report

Publication history

Received: Wed 08, Apr 2020
Accepted: Thu 23, Apr 2020
Published: Mon 27, Apr 2020

Copyright

© 2023 Ali Mahmood. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2020.04.08