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Pichioni P, Kokkinovasilis D, Stylianou S, Kipouridis G, Kalogeropoulos A, Al Mogrampi S. Multiple Muscle Metastases as the First Presentation of Gastric Cancer: A Case Report and Review of Literature. Cureus 2024; 16:e55458. [PMID: 38571840 PMCID: PMC10988182 DOI: 10.7759/cureus.55458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
The presence of an abdominal wall mass may serve as the initial presentation of an unknown gastric malignancy. The invasion of the abdominal wall and the occurrence of multiple skeletal muscle metastases originating from gastric cancer are exceedingly uncommon. We present a case of a 45-year-old female patient exhibiting widespread abdominal wall infiltration and skeletal muscle metastases derived from gastric cancer. The primary presentation included a distressing diffuse abdominal mass in the left upper and lower quadrants. Abdominal computed tomography revealed extensive swelling of multiple skeletal muscles within the abdominal wall, raising suspicions of gastric malignancy. Biopsies of the affected muscles, along with upper gastrointestinal tract endoscopy and colonoscopy, were performed. The upper endoscopy examination unveiled a poorly differentiated diffuse-type gastric adenocarcinoma, while the subsequent muscle biopsy confirmed infiltration by the recently diagnosed malignancy. At this stage of the disease, systemic chemotherapy was deemed the optimal choice for our patient. Subsequent abdominal computed tomography showed a decrease in the dimensions of the abdominal wall and other skeletal muscle lesions. Seventeen months after the initial diagnosis, our patient continues to be alive. Additionally, we provide a comprehensive review of the existing literature on similar reported cases of gastric cancer patients with concurrent muscle metastases.
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Affiliation(s)
- Polyxeni Pichioni
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| | | | - Stylianos Stylianou
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| | - Georgios Kipouridis
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
| | | | - Saant Al Mogrampi
- Department of Surgery, General Hospital of Imathia, Naousa Health Unit, Naousa, GRC
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Fukui Y, Kubo N, Sakurai K, Tamamori Y, Maeda K, Ohira M. Metachronous port site, muscular and subcutaneous metastases from a gastric adenocarcinoma: a case report and review of articles. Surg Case Rep 2021; 7:124. [PMID: 34013476 PMCID: PMC8134604 DOI: 10.1186/s40792-021-01202-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background Port site metastasis (PSM) after curative gastrectomy for gastric cancer and muscular metastasis from gastric cancer are rare manifestations. Similarly, subcutaneous metastasis from gastric cancer is rare, and muscular and subcutaneous metastases are associated with poor prognosis. We report a case of long-term survival in a patient who underwent curative resection of gastric cancer and repeated recurrence of port site, muscular and subcutaneous metastases from gastric cancer, treated by resection. Case presentation A 75-year-old man was diagnosed with gastric cancer and referred to our department. Upper endoscopy demonstrated a 5-cm circumferential ulcerated lesion at the cardia. Biopsy findings showed a poorly differentiated tubular adenocarcinoma. He underwent laparoscopic total gastrectomy with lymph node dissection, and pathologic examination revealed a moderately differentiated tubular adenocarcinoma stage T4aN1M0 and IIIA according to the UICC (Union for International Cancer Control) classification. He refused adjuvant chemotherapy and was only carefully observed. Twenty-three months after the primary gastrectomy, computed tomography (CT) revealed an irregular mass near the port site wounds. Then the patient underwent mass resection, and the pathological diagnosis was consistent with metastatic adenocarcinoma, located in the subcutaneous tissue at the port site wounds. Thirteen months after the second surgery, CT revealed an enhanced mass in the abdominal wall. Positron emission tomography (PET) CT showed an elevated uptake in the rectus abdominis muscle and a standardized uptake value (SUV) of 3.1. The patient underwent another mass resection, and the pathological diagnosis was consistent with metastatic adenocarcinoma in the rectus abdominis muscle. Thirty-five months after the third surgery, CT revealed a mass in the left gluteal subcutaneous region. Furthermore, PET-CT revealed a 35-mm mass with an elevated SUV of 9.6. Another mass resection procedure was performed, and the pathological diagnosis was consistent with metastatic adenocarcinoma in the subcutaneous tissue. Since tumor cells were present at the resection margin, additional radiation therapy was performed. The patient has survived 78 months after primary gastrectomy. Conclusion The prognosis of muscular and subcutaneous metastases from gastric cancer is poor. However, if the metastatic tumor is solitary, surgical excision could be a feasible treatment option and might prolong survival.
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Affiliation(s)
- Yasuhiro Fukui
- Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan.
| | - Naoshi Kubo
- Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Katsunobu Sakurai
- Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Yutaka Tamamori
- Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan
| | - Masaichi Ohira
- Department of Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-City, Osaka, 545-8585, Japan
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Jacob E, Smucker L, Crouse R, Allard-Picou A. Isolated brachioradialis metastasis of gastric adenocarcinoma after R0 resection. World J Surg Oncol 2021; 19:83. [PMID: 33743738 PMCID: PMC7981802 DOI: 10.1186/s12957-021-02191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric cancer is the fifth most common cancer worldwide, with an incidence of 6.72 per 100,000 people. Thirty-two percent of gastric cancer patients will live 5 years after diagnosis. Single-site metastasis is noted in 26% of patients with gastric cancer, most commonly in the liver (48%), peritoneum (32%), lung (15%), and bone (12%). Here, a case is presented in which a single skeletal muscle metastasis appeared after appropriate resection and treatment. CASE PRESENTATION A 63-year-old man underwent neoadjuvant chemotherapy and a multivisceral en bloc R0 resection. Final pathology showed no evidence of lymph node metastasis with 31 negative lymph nodes. Four months postoperatively, the patient was found to have a rapidly growing biopsy-proven extremity soft tissue gastric metastasis within the brachioradialis muscle. He subsequently underwent metastasectomy and immunotherapy. CONCLUSION This case is a rare example of an isolated extremity metastasis of gastric adenocarcinoma in the setting of an R0 resection of the primary tumor and negative nodal disease on final pathology, suggestive of hematogenous spread. We review the biology, workup, and management of gastric cancer and highlight new advancements in the treatment of this aggressive cancer.
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Affiliation(s)
- Elizabeth Jacob
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
| | - Levi Smucker
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA.
| | - Ryan Crouse
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
| | - Ayana Allard-Picou
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
- Columbia University College of Physicians and Surgeons, New York City, USA
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Aguirre LE, Salcedo J, Zuquello R, Garcia-Buitrago M, Ardalan B. Metastatic involvement of skeletal muscle from gastric adenocarcinoma. Oxf Med Case Reports 2019; 2019:omz081. [PMID: 31772748 PMCID: PMC6736074 DOI: 10.1093/omcr/omz081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/04/2019] [Accepted: 07/14/2019] [Indexed: 12/09/2022] Open
Abstract
Gastric cancer represents the fifth most common cancer diagnosis worldwide and the third leading cause of cancer-related mortality. In the USA, the overall 5-year survival rate is 31%, with distant disease nearing 5%. The most common sites of metastasis are the liver and peritoneum. Skeletal muscle involvement has been rarely reported. Since clinical and imaging findings overlap with primary sarcomas, a confirmatory biopsy is required for diagnosis. Prognosis remains poor with treatment options including palliative chemotherapy, radiotherapy and surgical resection. We report the case of a 57-year-old female presenting with extensive involvement of skeletal muscle 10 years after achieving remission. In addition to illustrating the refractoriness and poor outcomes associated with muscle involvement, this case and comprehensive review of the literature highlights important characteristics of disease biology and tumor genomics that warrant detailed discussion and exposition to a wider audience.
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Affiliation(s)
- L E Aguirre
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - J Salcedo
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - R Zuquello
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - M Garcia-Buitrago
- Department of Pathology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - B Ardalan
- Department of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Koga Y, Baba Y, Harada K, Kosumi K, Shigaki H, Kurashige J, Ishimoto T, Iwatsuki M, Miyamoto Y, Sakamoto Y, Yoshida N, Baba H. Multiple skeletal muscle metastases from poorly differentiated gastric adenocarcinoma. Surg Case Rep 2015; 1:105. [PMID: 26943429 PMCID: PMC4607684 DOI: 10.1186/s40792-015-0108-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/08/2015] [Indexed: 01/08/2023] Open
Abstract
We report here a rare case of gastric carcinoma with multiple intramuscular metastases. A 71-year-old man presented with rapidly evolving swelling of his left thigh and severe pain. Three years earlier, he had undergone neoadjuvant chemotherapy followed by gastrectomy for advanced gastric cancer. A computed tomography scan showed unusual swellings in multiple skeletal muscles with no vessel or bone invasion. Importantly, the affected muscles did not contain distinct masses but were diffusely enlarged. Pathological examination of an open muscle biopsy showed a poorly differentiated adenocarcinoma, supporting a diagnosis of gastric cancer metastases in multiple skeletal muscles.
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Affiliation(s)
- Yuki Koga
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Kazuto Harada
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Keisuke Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Hironobu Shigaki
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Junji Kurashige
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Takatsugu Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Yasuo Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Pergolini I, Crippa S, Santinelli A, Marmorale C. Skeletal muscle metastases as initial presentation of gastric carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:580-3. [PMID: 25544018 PMCID: PMC4281026 DOI: 10.12659/ajcr.891397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 67 Final Diagnosis: Metastatic gastric carcinoma Symptoms: Painful swelling of soft tissue Medication: Folinic acid • fluouracil • irinotecan Clinical Procedure: Radiological-pathological work-up Specialty: Oncology
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Affiliation(s)
- Ilaria Pergolini
- Department of General Surgery, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Stefano Crippa
- Department of General Surgery, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Alfredo Santinelli
- Department of General Surgery, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Cristina Marmorale
- Department of General Surgery, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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Lourenço LG, Carlotto JRM, Herbella FAM, Silva DAF, Setti HB. Muscular metastasis from gastric cancer. J Gastrointest Oncol 2014; 5:E100-2. [PMID: 25436130 DOI: 10.3978/j.issn.2078-6891.2014.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/23/2014] [Indexed: 11/14/2022] Open
Abstract
The association between gastric cancer and muscle metastasis is extremely rare. Few cases have been reported in the literature. We report a case of a 68-year-old man, with a diagnosis of gastric adenocarcinoma by endoscopy and biopsy. A painful nodule on the right thigh became noticeable during chemotherapy sessions, where positron emission tomography and percutaneous biopsy diagnosed a muscle metastasis of gastric adenocarcinoma. This report demonstrates the importance of further investigation of muscle lesion in patients with gastrointestinal cancer and how we can diagnose and treat these lesions.
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Affiliation(s)
- Laércio Gomes Lourenço
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Diego Adão Fanti Silva
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Henrique Barroso Setti
- Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Plagakis SA, Devitt PG, Thompson SK. Soft tissue metastases in oesophago-gastric cancer: importance of a detailed history. ANZ J Surg 2012; 81:835-6. [PMID: 22295429 DOI: 10.1111/j.1445-2197.2011.05879.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie A Plagakis
- University of Adelaide Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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10
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Diffuse skeletal muscle metastasis from gastric cancer similar to inflammatory disease: a report of two patients. CURRENT ORTHOPAEDIC PRACTICE 2010. [DOI: 10.1097/bco.0b013e3181c84691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tougeron D, Hamidou H, Dujardin F, Maillard C, Di Fiore F, Michel P. Unusual skeletal muscle metastasis from gastric adenocarcinoma. ACTA ACUST UNITED AC 2009; 33:485-7. [PMID: 19477611 DOI: 10.1016/j.gcb.2009.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 12/01/2022]
Abstract
Patients with gastric adenocarcinoma frequently develop hepatic metastases or peritoneal carcinosis but involvement of the skeletal muscle is extremely rare. We report the case of a 71-year-old man with a painful soft tissue mass in the right shoulder. Two years previously, the patient had been treated for a locally advanced gastric carcinoma (surgery plus chemoradiotherapy). Surgical exploration with biopsy showed skeletal muscle metastasis from the gastric adenocarcinoma in the deltoid muscle. Chemoradiotherapy resulted in complete regression of symptoms from the metastatic lesion. The patient is alive and free of recurrence in the deltoid muscle after a follow-up of 13 months. Based on this case study, the difficulty of diagnosing skeletal muscle metastases, the prognosis and treatment options are discussed.
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Affiliation(s)
- D Tougeron
- Digestive Oncology Unit, Department of Gastroenterology, Rouen University Hospital, Northwest Cancéropôle, Rouen, France.
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