Primary lung sarcoma with gastric metastasis and morphological divergence presenting as melena

Gastric metastasis from high-grade soft tissue sarcoma: a rare occurrence with literature review

Metastasis of high-grade soft tissue sarcoma to the stomach is an extremely rare occurrence. While sarcomas can spread to distant organs, they most commonly metastasize to the lungs, liver, and bones. We report a unique case of gastric metastasis from a high-grade soft tissue sarcoma, occurring 4 years after the initial diagnosis of fibrosarcoma in the right femoral region. The patient did not undergo adjuvant chemotherapy and developed a large soft tissue metastasis in the left gluteal region 2 years later. After 4 years, he presented with a second soft tissue metastasis and suspected metastatic lung nodules. Symptoms of melena and severe anemia prompted a gastroscopic examination, which revealed gastric metastasis from a high-grade soft tissue sarcoma. Due to severe anemia, a palliative gastric resection was performed. A review of the literature indicates that metastatic leiomyosarcomas are the most frequently reported sarcoma subtype metastasizing to the stomach.

Gastric Metastasis of Primary Lung Cancer: Case Report and Systematic Review With Pooled Analysis

Background

Gastric metastasis from lung cancer (GMLC) is a rare occurrence. The clinicopathological characteristics, outcomes, and prognostic factors remain largely elusive.

Methods

We conducted a systematic review on case reports and case series of GMLC by scanning MEDLINE, Embase, and ISI Web of Knowledge. Data involving the clinicopathological features, treatment, and outcomes were extracted and analyzed. Survival analysis was performed using Kaplan–Meier method. The Cox proportional hazards regression model was used to identify potential prognostic factors associated with survival. Furthermore, a case of metastatic gastric adenocarcinoma of pulmonary origin with epidermal growth factor receptor (EGFR) L858R+T790M mutation was also described and included.

Results

Seventy-eight records involving 114 cases (including ours) were finally included. The median age on admission was 65 years with a male predominance of 79.8%. Lung adenocarcinoma (42.1%), located in the right upper lobe (30.3%), was the most frequent primary tumor. Bleeding (36.7%) and abdominal pain (35.8%) were the two most common symptoms. Endoscopically, gastric lesions were typically presented as elevated lesions with or without volcano-like ulceration, or ulcerative lesions, mostly involving the gastric corpus. The median overall survival time and survival time after diagnosis of metastatic cancer were 11 months [95% confidence interval (CI): 7–14] and 4.5 months (95% CI: 3–9), respectively. The survival analyses revealed that surgical interventions (including lung surgery and/or abdominal surgery) and systemic therapy (including chemotherapy, radiotherapy, and/or targeted therapy) seemed to be positive prognostic factors for both overall survival and survival after diagnosis of metastatic cancer.

Conclusions

Clinicians should be alerted to the occurrence of gastric metastasis in lung cancer patients. Comprehensive evaluation and appropriate treatment for specific patients may improve the survival rate of GMLC patients.