Cheek mass as a presentation of metastatic rectal cancer

Cheek metastasis from colorectal cancer is very unusual. We report on a 79-year-old female rectal cancer patient who underwent low anterior resection and lymph node dissection. The initial stage for this patient was T3N0M0 (by AJCC 1997). Postoperatively 49 months later, she presented with a right cheek mass that progressively enlarged within 2 weeks. Computed tomographic (CT) scan showed a well-defined 5 x 5-cm mass over the right parotid space and infratemporal fossa. The tumor was noted to be displacing the right masseter muscle laterally with obliteration of the medial border. In addition, destruction of the right mandible was also noted. Histology of this right cheek mass revealed it to be a metastatic adenocarcinoma, which was similar to that of the primary rectal adenocarcinoma. Multiple metastases including to the bone, lung, and liver were also found. The patient only underwent radiotherapy to the right cheek mass because of its rapid growth. Chemotherapy was not considered due to her advanced age. She did not complete the entire radiation therapy course because she expired. In our review, this is a very rare case presenting with cheek mass metastasis from rectal carcinoma. It was associated with widespread and aggressive disease due to rectal cancer.