A Case of Rectal Cancer Recurrence with a Solitary Lymph Node Metastasis Anterior to the Inferior Vena Cava

Abstract

A 69-year-old man was diagnosed with anastomotic recurrence two and a half years after he underwent lower anterior resection for Stage IIIa upper rectal cancer. In a preoperative examination, contrast-enhanced CT showed a smooth-contour tumor of 2 cm in diameter anterior to the inferior vena cava. The tumor adjoined the inferior part of the third portion of the duodenum and had enlarged over time. FDG positron emission tomography showed abnormal uptake in the tumor. As we considered that the tumor was derived from retroperitoneum tissue, we first performed super-low anterior resection with a diverting ileostomy for anastomotic recurrence. However, endoscopic ultrasonographic fine needle aspiration cytology after surgery strongly suggested that the tumor was an adenocarcinoma. Since no other primary lesions were found, the tumor was diagnosed as recurrence of rectal cancer and was resected at the time of stoma closure. The pathological findings were consistent with metastasis of rectal cancer.