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Hao W, Chang R, Liu J, Wang Y, Ren M, Xin K, Liu B, Xie J, Yang Y. Case report: A case of advanced gastric cancer with multiple skin metastases, with significant relief from immunotherapy. Front Immunol 2024; 15:1356350. [PMID: 38500887 PMCID: PMC10946408 DOI: 10.3389/fimmu.2024.1356350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/06/2024] [Indexed: 03/20/2024] Open
Abstract
Gastric cancer is the fifth leading cause of cancer-related mortality worldwide, with a low 5-year survival rate in advanced stages. Cutaneous metastasis is rare in gastric cancer, with only 0.8-1% incidence. We reported a rare case of female gastric cancer. The patient had undergone subtotal gastrectomy and chemotherapy 13 years ago, followed by a subsequent surgery of residual stomach, partial jejunum, and partial colon resection 11 years later. The pathological examination revealed poorly differentiated stomach adenocarcinoma, Lauren classification: diffuse type. The patient received 2 cycles of SOX chemotherapy. Two years later, cauliflower-like skin nodules, which were surgically excised, appeared on the back. The histopathological examination showed a spindle cell tumor; no specific anti-tumor treatment was administered. Six months later, the skin lesions increased in size and number, spreading to the neck, chest, and abdomen, presenting as erythematous patches with some cauliflower-like elevations. A skin biopsy of a 1cm0.5cm0.3cm lesion on the left abdomen was performed, and based on the immunohistochemistry, clinical history, and the possibility of metastatic or infiltrating adenocarcinoma, the gastrointestinal origin was highly suspected. Genetic testing was performed on the gastric recurrence and skin lesions, revealing 103 shared genetic variations, further suggesting the skin metastasis originated from gastric cancer. Subsequently, the patient received 10 cycles of immunotherapy combined with intravenous chemotherapy (200mg Tislelizumab and 100mg albumin-bound paclitaxel). The treatment response was evaluated as partial remission, with significant improvement in the skin lesions compared to before. This case highlights the possibility of tumor metastasis in patients with extensive skin lesions in advanced gastric cancer. Early examination, diagnosis, skin biopsy, immunohistochemistry, and genetic sequencing are recommended.
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Affiliation(s)
- Wen Hao
- Department of Oncology, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Ruimin Chang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jingxin Liu
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yibing Wang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Meijin Ren
- Department of Oncology, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Kai Xin
- Department of Oncology, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Baorui Liu
- Department of Oncology, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jiaqi Xie
- Department of Oncology, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yang Yang
- Department of Oncology, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
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Yao GL, Tao YJ, Fan YG. Cutaneous metastasis from gastric cancer: Manifestation, diagnosis, treatment and prognosis. Eur J Surg Oncol 2024; 50:107939. [PMID: 38219697 DOI: 10.1016/j.ejso.2023.107939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Cutaneous metastasis from gastric cancer is very rare. The understanding of this disease is incomplete. This situation delays its diagnosis and treatment, followed by poor prognosis. Here, we first report a study based on a network to improve the diagnosis, treatment and prognosis of cutaneous metastasis from gastric cancer. METHODS A comprehensive search of PubMed was performed. All studies on cutaneous metastasis from gastric cancer were collected. The publication date was limited from 2000 to the present, and the language was limited to English. SPSS 26.0 was employed for statistical analysis. RESULTS Seventy-two patients were included. The average patient age was 60.0 ± 16.0 years. In total, 72.2 % of the patients were male. The most common manifestation was nodular skin lesions (45.8 %). The metastases generally presented as multiple lesions (61.1 %). The most common metastasis location was the thoracoabdominal wall (56.9 %). 64.7 % of the patients simultaneously had extracutaneous metastases. Most of the tumors were poorly differentiated carcinomas (87.5 %), and 66.1 % had signet ring cells. 40.8 % of the cutaneous metastases presented as primary manifestations. Only 9.6 % had their diagnosis as soon as the cutaneous metastasis emerged. Systemic chemotherapy (65.6 %) was the most common treatment strategy, followed by radical surgery (12.5 %). The median overall survival was only 6 months. The median overall survival of 5 patients with resected tumors was 48 months. CONCLUSION Cutaneous metastasis from gastric cancer usually manifests as an emerged nodule or erysipelas-like skin lesion. Resection of the cutaneous lesion could be helpful for patients with local metastases.
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Affiliation(s)
- G L Yao
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 471000, China
| | - Y J Tao
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 471000, China
| | - Y G Fan
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Luoyang, 471000, China.
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De Giorgi V, Scarfì F, Trane L, Silvestri F, Maida P, Gori A, Covarelli P. Appearance of cutaneous melanoma and subcutaneous metastases in metastatic gastric carcinoma undergoing chemotherapy with oral 5-fluorouracil prodrug. Anticancer Drugs 2019; 30:1055-1057. [PMID: 31609761 DOI: 10.1097/cad.0000000000000828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metastatic skin lesions of gastric cancers usually appear as nonspecific, firm, and hyperpigmented nodules. However, they occasionally present as unusual skin manifestations that mimic other skin disorders. We describe a case of multiple cutaneous metastases from gastric cancer resembling sebaceous cysts with a synchronous melanoma, in a patient after fluoropyrimidine-based systemic chemotherapy. Melanoma occurring as a second cancer has been recognized in patients having undergone previous chemotherapy or radiation for another cancer. We can assume that the capecitabine-based chemotherapy may have played a role in the development of the melanocytic neoplasm. Our observation adds extra evidence to the link between fluoropyrimidine-based immunosuppression and the induction of melanocytes' proliferation and transformation. For these reasons, it is advisable to require dermatological checkups for patients undergoing chemotherapy treatments in order to identify suspicious melanocytic lesions as soon as possible.
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Affiliation(s)
| | | | - Luciana Trane
- Department of Dermatology, University of Florence, Florence
| | | | | | - Alessia Gori
- Melanoma section, Cancer Research 'AttiliaPofferi' Foundation, Pistoia
| | - Piero Covarelli
- Department of Surgery, University of Perugia, Perugia, Italy
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Tas F, Ciftci R, Buyukbabani N, Karabulut S. Recurrent gastric cancer presenting with both scrotal and facial skin metastases: a case report. J Gastrointest Cancer 2013; 45:96-9. [PMID: 23430387 DOI: 10.1007/s12029-013-9484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Faruk Tas
- Institute of Oncology, University of Istanbul, Capa, Istanbul, 34390, Turkey,
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Affiliation(s)
- Wen-Hsin Huang
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Abstract
Cutaneous metastases of internal malignancies still seem to occur infrequently, although medical publications report an incidence rate of up to 10.4%. Common sense, however, fosters suspicion that we might underdiagnose the problem distracted by harder striking facets of an advanced disease. With contemporary knowledge, morphology and behavior of cutaneous metastases resemble each other regardless of the site of origin. This article itemizes clinical presentations according to organ systems, specific features, and differential diagnoses. In general, the survival turned out to be less than 12 months. But incremental awareness of cutaneous metastases proclaims this paradigm insufficient. Although excision is the local treatment of choice, investigations attempt to propose tumor-specific chemotherapeutic/immunological approaches. This paper endeavors to critically review the state of the art concerning the clinic, prognosis, and therapeutic concepts.
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Affiliation(s)
- Dorothée Nashan
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany.
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Malek J, Abbas O, Ghosn S, Salman S. Multiple nodules and plaques over the abdomen. Clin Exp Dermatol 2010; 35:e190-2. [PMID: 20518912 DOI: 10.1111/j.1365-2230.2009.03723.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- J Malek
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
INTRODUCTION Distant metastases to the head and neck region, with primary tumor located outside the head and neck, presents often a diagnostic problems, especially when metastases are an exclusive signs and symptoms of the disease. In most of this cases there is no chance for curative therapy, and optimum palliation is the goal of the treatment. AIM The description and analysis of clinical and prognostic factors, which could establish the optimum diagnostic formula, and predict the prognosis in distant metastases to the head and neck region. MATERIAL AND METHODS The study of 44 cases diagnoses and treated in 2001-2006 in Dept. ORL H&N Surgery. The analysis was based on current observations and case records documentation. RESULTS/CONCLUSIONS In the most of cases (39/44) the distant metastases to the head and neck regions presented a part of generalized malignant neoplastic disease, but in 14/44 cases that was a first warning symptom. All of this 14/44 cases presented as a metastases to the IV and V lymph nodes region. The most common primary sides were found in the lung. The average survival within the analyzed group was only 7,2 months.
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Frey L, Vetter-Kauczok C, Gesierich A, Bröcker EB, Ugurel S. Cutaneous metastases as the first clinical sign of metastatic gastric carcinoma. J Dtsch Dermatol Ges 2009; 7:893-895. [PMID: 19538484 DOI: 10.1111/j.1610-0387.2009.07102.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cutaneous metastases from gastric cancer are uncommon with a frequency of 7 % but can rarely be the presenting sign. A 54-year-old man complained of multiple pea-sized scalp nodules which had been present for four months. Histology showed a metastatic adenocarcinoma. Initial evaluation revealed liver metastases and gastroscopy then identified a tumor involving the distal esophagus and gastric cardia that was diagnosed as a gastric tubular carcinoma. The patient had a good response to polychemotherapy. While gastric carcinoma generally metastasizes to the abdominal wall or lymph nodes, our patient showed an exceptional variant with distant cutaneous metastases as the first clinical sign.
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Affiliation(s)
- Lidia Frey
- Department of Dermatology, University of Wuerzburg, Wuerzburg, Germany
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