Colon Cancer with Mediastinal Metastasis

Background: The patient had a CAF (complete atrial fibrillation) as a comorbidity. Objective: The most common sites of colon cancer metastasis are the regional lymph nodes, liver, lung, bone and brain. The patient was 65 years old and had CAF as a comorbidity. She was consulted for a recent dyspnea evolving in a context of altered general state without any digestive sign. A thoracic scan showed a medial mass measuring 53*56*60mm. The lung biopsy revealed a muscular adenocarcinoma of colorectal origin with immunohistochemical expression of cytokeratin 7 (CK7), 20 and cytokeratin (CK) AE1/AE3, CDX2.The Pet Scan confirmed the existence of a hypermetabolic left anterosuperior medial mass in addition to a focal digestive hypermetabolism of the right colonic wall. A colonoscopy was performed and showed a tumor process in the right colon with a histological and immunohistochemical profile compatible with that of the mediastinal metastasis. The tumor was MSS (microsatellite stable), RAS (rat sarcoma) and BRAF(v-raf murine sarcoma viral oncogene homolog B1)wild type. The patient received a 3-month folfox-panitimumab combination with good tolerance and a partial response of about 50% on the metastasis. Conclusions: This case report provide a highly unusual instance of colon adenocarcinoma with extensive mediastinal lymph nodes metastasis.