Myelophthisis as a solitary manifestation of failure from rectal carcinoma- A Batson phenomenon?

Rectal carcinoma is uncommonly associated with systemic metastases in the a bsence of liver metastases, reflecting the predilection for spread via the portal system. Occasionally, isolated lung metastases are seen, which are u sually attributed to spread via the portosystemic anastomoses in the distal rectum. However, myelophthisis is an unreported complication of rectal can cer as an isolated form of systemic failure. We present a case of fatal mye lophthisis associated with otherwise localized rectal carcinoma secondary t o metastatic rectal cancer. This observation led to the hypothesis that spr ead to the bone marrow occurred via a "third circulation," the Batson plexu s, a network of deep pelvic veins with rich anastomoses to the vertebral pl exus.