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Case: A 9 x 4 cm tumor was found at the rectosigmoid junction during dissection of a 64-year-old man whose cause of death was failure to thrive. Possible metastases to the abdominal and thoracic lymph nodes, lungs, right adrenal gland, and brain were found. Findings: Histology showed a well- to moderately-differentiated adenocarcinoma arising in the mucosa, invading the submucosal lymphatics, and extending through the muscularis externa. The adrenal lesion was morphologically similar to the colorectal tumor. Discussion: Primary treatments for metastatic colorectal cancer include resection and chemotherapy. More recent targeted treatments based on molecular testing have improved survival rates.