Abstract

A 72-year-old man underwent Miles operation for curative excision of adenocarcinoma infiltrating 1/3 distal part of the rectum and extending to the anal canal. He received adjuvant radiotherapy postoperatively. Fifty-four months after the operation, he presented with right supraclavicular lymphadenopathy 2 cm in diameter and a swelling in the right lower extremity. Clinical and pathological evaluations showed metastatic involvement of the right supraclavicular lymph node, lung, bone, and pelvic lymph nodes. Chemotherapy and palliative radiotherapy were initiated. Papular skin lesions were noted in the 1/3 middle part of the right thigh after the fourth cycle of chemotherapy. Pathologic examination of the skin lesions showed metastasis of adenocarcinoma, for which second-line chemotherapy and palliative radiotherapy were initiated. The patient died of disease progression eight months after recurrence.