[Axillary Lymph Node Recurrence after Curative Surgery for Transverse Colon Cancer-A Case Report]

We report the rare case of an 89-year-old female with axillary lymph node recurrence after curative surgery for transverse colon cancer who had undergone right hemicolectomy with D3 lymphadenectomy with an uneventful postoperative course. Pathological examination confirmed the tumor's status as tub2>sig, T4aN3M0, and pStage Ⅲc, and signet-ring cell carcinoma was remarkably found in the metastatic lymph node. Genetic testing revealed wild-type RAS, a BRAF mutation, and a high MSI. After 9 months of follow-up without adjuvant chemotherapy, CEA increased sharply to 41.3 ng/mL by 9 months postoperatively, and CT showed nodules in the right axilla, adrenal gland, and retroperitoneum. PET-CT showed abnormal fluorodeoxyglucose uptake in the same regions. A core needle biopsy of the axillary lymph node revealed signet-ring cell carcinoma, which was diagnosed as a recurrence of transverse colon cancer. Although we suggested chemotherapy due to the unresectable recurrence of colorectal cancer, she preferred to receive supportive care instead. Three months after the recurrence was diagnosed, CEA increased to 248.4 ng/mL, and CT showed enlargement of the axillary lesion and a new lesion in the hilum of the lung.