Case Report - (2019) Volume 13, Issue 1
Received: 02-Mar-2019
Published:
19-Mar-2019
Citation: Jian-Jiao C, Zhao W (2019) Secondary Multiple Cutaneous Metastases from Primary Gastric Signet-Ring Cell Adenocarcinoma. J Mol Genet Med 13: 414 doi:10.4172/1747-0862.1000414
Copyright: © 2019 Jian-Jiao C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
A 60-year-old man was diagnosed with gastric cancer by endoscopy in our cancer center. Preoperative CT scan showed thickening of the cardia and enlarged lymph nodes in hepatogastric space. Consequently, he accepted total gastrectomy and Roux-en-Y reconstruction. Immunohistochemical detection showed intense positivity for GST-n and Pgp antibodies and negativity for EGFR, ERCC1, P53, Ki67 and HER-2. Surprisingly, within one month, the patient had multiple asymptomatic cutaneous nodules in the left neck, right subclavian, left armpit, left upper abdomen, lower abdomen, right groin and lumbodorsal region. Abdominal CT scan showed a 22 × 22 mm highdensity lesion in the splenorenal space, as well as cutaneous nodules in the left upper abdomen, lower abdomen and right groin. Histopathologic examination of cutaneous biopsy showed a poorly differentiated signet-ring cell carcinoma consistent with a diagnosis of secondary metastasis of primary gastric carcinoma. The patient received “DOF” chemotherapy which do benefit to halt the disease progression. He decided not to continue with chemotherapy and died of multiorgan metastasis 2 months later.
Gastric cancer; Adenocarcinoma; Cutaneous metastases; Chemotherapy
Cutaneous metastasis is believed to be a late manifestation of primary malignancy. It usually takes a long-run development for emergence of cutaneous metastasis from primary malignancy. Cutaneous metastasis from gastric carcinoma is extremely rare, occurring in only 0.4-4.5% of all gastric carcinomas [1]. The occupied proportions of gastric adenocarcinoma are higher relatively in gastric tumors. Gastric signet-ring cell adenocarcinoma account for 9.4% of all gastric carcinomas [2]. Patients diagnosed with gastric signet-ring cell carcinoma are thought to have poorer prognosis and lower survival compared with patients with gastric mucinous carcinoma [3].
We present a case of secondary multiple skin metastases from a primary gastric signet-ring cell adenocarcinoma. The case is intriguing as skin metastasis from gastric adenocarcinoma is uncommon, and location of the lesions, which served as the first sign of recurrent gastric cancer, is quite unusual.
A 60-year-old man presenting with a 3-month history of vomiting and weight loss was diagnosed with gastric cancer by endoscopy in our cancer center. Abdominal enhanced CT scan showed thickening of the cardia and enlarged lymph nodes in the hepatogastric space (Figure 1). Pathology of gastric endoscopic biopsy specimens showed a poorly differentiated adenocarcinoma (Figure 2). He accepted total gastrectomy (D2 lymphadenectomy) and Roux-en-Y reconstruction. The lesion, measuring 5 × 3 cm, was located in the upper gastric body near the lesser curvature. Pathology of the resected specimens showed a poorly differentiated gastric signet-ring cell carcinoma with lymphatic invasion and tumor metastasis was identified in 4 of 16 dissected lymph nodes in gastric lesser curvature (Figure 3). Immuno-histochemical detection showed intense positivity for GST-π (glutathione S-transferase-pi) and Pgp (P-glycoprotein) antibodies and negativity for EGFR, ERCC1, P53, Ki67 and HER-2.
Figure 1. Abdominal enhanced CT scan showed thickening of the gastric wall and regional lymphadenopathy in hepatogastric space.
Figure 2. Gastric endoscopic biopsy specimens pathology revealed poorly differentiated adenocarcinoma.
Figure 3. Pathological diagnostic findings of the resected specimens revealed poorly differentiated gastric signet-ring cell carcinoma.
One month after surgery, asymptomatic cutaneous nodules developed on his left neck, involving the right subclavian, left armpit, left upper abdomen, lower abdomen, right groin and lumbodorsal region (Figure 4). Most nodules had normal overlying skin, developing from spot to nodular lesion measuring ~3 cm in diameter.
Figure 4. The patient presented with development of asymptomatic cutaneous nodules on his left neck, progression of involvement to right subclavian, left armpit, lower abdomen, right groin and lumbodorsal region occurred.
Abdominal CT scan revealed a 22 × 22 mm high-density lesion in the splenorenal space, and cutaneous nodules in the left upper abdomen, lower abdomen and right groin (Figure 5). The multiple cutaneous nodules were resected immediately. Histopathologic examination showed a poorly differentiated signet-ring cell carcinoma consistent with diagnosis of secondary metastases of primary gastric carcinoma (Figure 6).
Figure 5. Abdominal CT examination revealed multiple high density soft tissue lesions in splenorenal space. Some cutaneous nodules were also found.
Figure 6. Histopathologic examination of excised cutaneous tumors revealed a poorly differentiated signet-ring cell carcinoma.
We developed intravenous “DOF” combination chemotherapy protocols based on his pathologic results and immuno-histochemical findings. He was given docetaxel (75 mg/m2), oxaliplatin (130 mg/m2) and 5-fluorouracil (750 mg/m2) every 28 days, for 2 cycles. And then he accepted one cycle of oral anti-cancerogenics treatment (tegafur, gimeracil, and oteracil 25 mg/m2, twice a day, for 28 days), followed by 14 days of rest. “DOF” chemotherapy, which last for 3 months, do benefit to halt the disease progression. However, he suffered from side effects of chemotherapy painfully. The patient refused to continue with chemotherapy at hospital, in turn, to travel to the places his fancy took him. Eventually, he died due to multiorgan metastasis 2 months later.
Cutaneous metastasis of gastric signet-ring cell adenocarcinoma is rare, and may present with unusual clinicopathological features, rendering diagnosis challenging. In such cases, cutaneous metastasis of cancer generally appears late in the course of the disease. Adjuvant chemotherapy and nutritional support in addition to surgical operation may do benefit to prolong patient survival.
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Written informed consent was obtained from the patient’s family for publication of this case report and any accompanying images.
These authors declare that they have no competing interests.
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