Ileal lymphatic metastases from cecal carcinoma.

Abstract

Involvement of the terminal ileum in cases of cecal carcinoma usually results from direct extension through the cecal wall and ileocecal valve. Extensive lymphatic metastasis from cecal carcinoma can result in deranged lymphatic flow and apparently cause metastatic involvement of the ileum and its mesentery in the absence of direct extension. Three cases with the lymphatic obstruction pattern are described. Demonstration of these changes on antegrade small bowel examination indicates that extensive lymphatic metastasis has occured and that resection will not be curative.

Carcinoma of the hepatic flexure with proximal lymphatic invasion mimicking Crohn's disease

“…On small bowel examination there is a "cobblestone" appearance in terminal ileum and thickening of ileocecal valve regional lymph nodes by the tumor [1,2,4]. Infiltration of the intestinal wall around the submucosal lymphatic chains allows metastatic deposits in atypical locations [1,2]. In the initial stages, edema in the wall of the ileum and the colon is demonstrated on radiographs as mucosal thickening of ileal folds and loss of haustration in the colon [2].…”

“…Infiltration of the intestinal wall around the submucosal lymphatic chains allows metastatic deposits in atypical locations [1,2]. In the initial stages, edema in the wall of the ileum and the colon is demonstrated on radiographs as mucosal thickening of ileal folds and loss of haustration in the colon [2]. As the metastatic lymphatic edema' increases, nodular tumor deposits occur and leave "thumbprint" images in the colon and a "cobblestone" appearance in the ileum.…”

“…Preoperative recognition of the true nature of the lesion is important, since in these cases resection will not be curative because of the extensive node invasion (2). The prognosis in these patients is notably somber.…”