Rare case of cecal carcinoma surrounding the femoral head along the psoas major muscle

A 52-year-old female was admitted to our hospital with a 10-month history of abdominal mass in her right lower abdomen. Physical examination revealed a palpable hard mass, poor mobility, mild tenderness, redness on the surface of the skin, and no signs of tenderness, rebound pain, or muscle tightness, in the right lower abdomen and upper 1/3 of the right thigh, and limited range of motion in the right hip. Other physical examinations were normal. Laboratory investigations, including routine blood tests, liver and kidney function, tumour markers, and urine and stool tests, were unremarkable. Adenocarcinoma was shown on biopsy. Computed tomography (CT) scans revealed an irregular soft tissue mass, originating from the cecum and encasing the right femoral head along the psoas major muscle, in the right iliac fossa to inguinal region, with unclear boundary and equal or slightly lower density. The lesion showed mild to moderate uneven enhancement in contrast-enhanced scan and the boundary between the lesion and the right external iliac artery and vein was unclear, which was slightly compressed and displaced anteriorly (Fig. 1). Due to the advanced stage of the disease and involvement of the hip joint, a multidisciplinary team (MDT) comprising of oncologists, surgeons, and orthopaedic specialists was involved in the management of this case. The patient received FOLFOX/FOLFIRI chemotherapy and bevacizumab treatment to target the primary tumour and metastatic disease. However, the tumour did not respond to conversion therapy, and the TRG score was 3. Patient surgical intervention was considered and an open abdominal exploratory procedure was performed. During the operation, the main part of the mass was tightly attached to the external iliac and femoral arteries. Under the condition of protecting the femoral head, external iliac artery and femoral artery, the entire right colon and tumour combined with inguinal ligament were completely resected. Unfortunately, damage to the external iliac artery occurred, necessitating femoral artery repair (Fig. 2). The patient ultimately underwent a successful R0 resection, recovering well after the surgery with normal lower limb function. Following the operation, the patient received FORFIRI chemotherapy 2 months later. However, 1-year post-operation, local recurrence was detected. Unfortunately, the patient passed away 2 years after the operation. The rarity of this case lies in the uncommon metastasis to the hip joint, which posed diagnostic and therapeutic challenges. In rare instances, it can affect adjacent structures, presenting unique diagnostic and therapeutic challenges.1-3 Metastasis of cecal carcinoma to the hip joint is extremely rare, and literature on management in such cases is limited. A multidisciplinary approach involving oncologists, surgeons, and orthopaedic specialists is crucial for decision-making and optimal management. This case demonstrates that surgical intervention remains an effective option for certain patients with advanced cancer. The goal of surgery is to completely remove the tumour, alleviate symptoms, and improve the patient's quality of life. However, for each individual case, MDT need to consider the patient's overall condition and the characteristics of the tumour to determine the optimal treatment strategy. Yajun Luo: Conceptualization; funding acquisition; project administration; software; validation; visualization; writing – original draft; writing – review and editing. Zijian Deng: Data curation; resources. Bo Song: Conceptualization; resources; supervision; writing – original draft; writing – review and editing.