PMC6477500_01
Computed tomography findings. The perforated sigmoid colon cancer and Fournier gangrene observed 5 years ago (a) and the current abdominal wall metastasis (arrowhead) near the left inguinal region (b).
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F1
Computed tomography (CT) imaging that had been conducted showed abscess formation and air density from the left inguinal region to the left lower abdominal wall, indicating Fournier gangrene formation (Fig. 1a). The contrast-enhanced CT performed at another facility revealed an enhanced mass in the left abdominal wall (Fig. 1b), following which he was referred to our facility for further assessment and treatment of a palpable mass. The contrast-enhanced CT revealed a well-circumscribed left lower abdominal intramuscular mass measuring 50 x 30 mm (Fig. 1b); no peritoneal dissemination, ascites, or distant-organ metastasis were detected.
Intraoperative findings. Abdominal wall metastasis is observed as a mass covered with normal peritoneum (a). A surgical margin of 2 cm along the tumor contour is marked using a dye (b). An entire circumferential incision of the peritoneum is performed for tumor resection (c), and the resulting abdominal wall defect is approximately 8 cm in diameter (d).
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F2
The tumor was visible as a mass covered by a normal peritoneum (Fig. 2a). A surgical margin of 2 cm along the tumor contour was marked using a dye guided by external palpation (Fig. 2b). An entire circumferential incision of the peritoneum was performed using laparoscopic coagulating shears and electric cautery (Fig. 2c), and the depth of the incision was set at the level of subcutaneous fat tissue, with no exposure of skin to prevent cutaneous ischemia and necrosis. The resultant abdominal wall defect measuring 8 cm was covered with skin and subcutaneous tissue (Fig. 2d) but was left unreconstructed.
Tumor specimen and pathological findings. The resected specimen is a poorly marginated, whitish, nodular lesion measuring 5 x 3.5 x 1.5 cm (a, b) that was pathologically characterized as an adenocarcinoma with irregular and fused ductal structure, similar to the colorectal adenocarcinoma (c). HE. x100. The immunohistochemical staining was positive for CDX-2 (d).
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F3
The resected specimen was a poorly marginated, whitish, nodular lesion measuring 5 x 3.5 x 1.5 cm (Fig. 3a, b) that was pathologically characterized as an adenocarcinoma with irregular proliferations and a fused ductal structure (Fig. 3c). Moreover, calcification was observed, and immunohistochemistry revealed CDX-2 positivity (Fig. 3d).