1
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Kohno S, Ikegami M, Yamamoto SR, Aoki H, Ogawa M, Yano F, Eto K. A rare case of colorectal metastasis found 8 years and 10 months after gastrectomy for advanced gastric cancer: A case report and literature review. Oncol Lett 2023; 25:203. [PMID: 37123025 PMCID: PMC10131265 DOI: 10.3892/ol.2023.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/24/2023] [Indexed: 05/02/2023] Open
Abstract
Colorectal metastasis from gastric cancer is rare and may develop several years after gastric cancer surgery. Therefore, colonoscopic findings provide useful diagnostic information. The present report describes a case of gastric cancer colon metastasis diagnosed 8 years and 10 months after gastrectomy for advanced gastric cancer. A 64-year-old male patient underwent gastrectomy in December 2010 and received chemotherapy for 4 years and 10 months after the surgery. Subsequently, the patient was diagnosed as having colorectal cancer by computed tomography in February 2019. Colonoscopy revealed linitis plastica-like colon stenosis; however, biopsy pathology did not reveal any findings indicating malignancy. Right hemicolectomy was performed, and pathological examination revealed colon metastasis from gastric cancer. The patient received chemotherapy but died of peritoneal carcinomatosis 1 year and 8 months after the colectomy. According to literature, colorectal metastasis from gastric cancer is often attributed to hematogenous metastasis and often exhibits characteristic macroscopic features. Treatments, such as chemotherapy for gastric cancer and/or colorectal resection, are considered effective for gastric cancer colorectal metastasis.
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Affiliation(s)
- Shuzo Kohno
- Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo 125-8061, Japan
- Correspondence to: Dr Shuzo Kohno, Department of Surgery, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8061, Japan, E-mail:
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University Katsushika Medical Center, Tokyo 125-8061, Japan
| | - Se Ryung Yamamoto
- Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo 125-8061, Japan
| | - Hiroaki Aoki
- Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo 125-8061, Japan
| | - Masaichi Ogawa
- Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo 125-8061, Japan
| | - Fumiaki Yano
- Department of Surgery, The Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, Tokyo 105-8461, Japan
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2
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Shima T, Arita A, Sugimoto S, Takayama S, Kawaguchi N, Imai Y, Kitahara T, Maeda T, Okuda J. Simultaneous colonic metastasis of advanced gastric cancer: a case report. Surg Case Rep 2023; 9:39. [PMID: 36930379 PMCID: PMC10023818 DOI: 10.1186/s40792-023-01622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Although distant metastasis in gastric cancer can be present at the time of the initial diagnosis, colonic metastasis is extremely rare. This report describes a case of simultaneous colonic metastasis of advanced gastric cancer. CASE PRESENTATION The patient was a 78-year-old woman with nausea and epigastric pain. Upper gastrointestinal endoscopy revealed an advanced invasive ulcerative tumor in the lesser curvature of the stomach extending from the anterior to the middle portion. Colonoscopy revealed a 4-mm polyp-like lesion in the mid-transverse colon; therefore, a polypectomy was performed. Both gastric and colonic tumors showed poorly differentiated adenocarcinoma with signet ring cell carcinoma. After providing informed consent, the patient underwent a total gastrectomy. Histologic examination showed similar morphologic features of both gastric and colonic tumors. Immunohistochemistry staining showed that these tumor cells were positive for cytokeratin (CK) 7 and negative for CK20. CONCLUSIONS This was an extremely rare case of simultaneous colonic metastasis of advanced gastric cancer. Because missed metastasis can result in a poorer prognosis, we propose a systemic search including colonoscopy for patients with advanced gastric cancer, especially cases involving poorly differentiated adenocarcinoma or signet ring cell carcinoma.
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Affiliation(s)
- Takafumi Shima
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan.
| | - Asami Arita
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Satoshi Sugimoto
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Shoichi Takayama
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Nao Kawaguchi
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshiro Imai
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Tomohiro Kitahara
- Department of Gastroenterology, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Tamaki Maeda
- Department of Pathology, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Junji Okuda
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
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3
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Natsui K, Maruyama M, Terai S. A difficult‐to‐diagnose case of Borrmann type
IV
gastric cancer with marked transverse colon stenosis. JGH Open 2022; 6:812-814. [DOI: 10.1002/jgh3.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Kazuki Natsui
- Department of Gastroenterology Kashiwazaki General Hospital and Medical Center Kashiwazaki Niigata Japan
- Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences, Niigata University Chuo‐Ku Niigata Japan
| | - Masaki Maruyama
- Department of Gastroenterology Kashiwazaki General Hospital and Medical Center Kashiwazaki Niigata Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology Graduate School of Medical and Dental Sciences, Niigata University Chuo‐Ku Niigata Japan
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4
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Carboni F, Zazza S, Bertini L, Diodoro MG, Valle M. Remarkable survival of operated stage IV gastric cancer with resected late isolated colon metastasis. Clin Res Hepatol Gastroenterol 2022; 46:101917. [PMID: 35398563 DOI: 10.1016/j.clinre.2022.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Fabio Carboni
- Peritoneal Tumours Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy.
| | - Settimio Zazza
- Peritoneal Tumours Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Bertini
- Department of Radiology, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Grazia Diodoro
- Department of Pathology, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS, Regina Elena National Cancer Institute, Rome, Italy
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5
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Then EO, Grantham T, Deda X, Ramachandran R, Gaduputi V. Metastatic Gastric Cancer to the Colon. World J Oncol 2021; 12:127-131. [PMID: 34349858 PMCID: PMC8297054 DOI: 10.14740/wjon1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/29/2021] [Indexed: 12/09/2022] Open
Abstract
Gastric cancer is one of the most common and deadly cancers worldwide, especially amongst older males. Current data suggest gastric cancer is the fifth most common neoplasm and the third most deadly cancer, with an estimated 783,000 deaths in 2018. Risk factors associated with the development of gastric cancer include obesity, gastroesophageal reflux disease, Helicobacter pylori infection, and low socioeconomic status. Diagnosis of gastric cancer can be accomplished by endoscopy, which allows the clinician to obtain a biopsy specimen. Endoscopic ultrasound is also an important modality that is helpful in assessing tumor invasion. The most common sites of metastatic gastric cancer in descending order are the liver, peritoneum, lung and bone. Rarely will gastric cancer metastasize to the colon. Here we present a rare case of colonic metastasis of a primary gastric adenocarcinoma.
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Affiliation(s)
- Eric Omar Then
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA.,Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY, USA
| | - Tyler Grantham
- Department of Internal Medicine, St. George's University School of Medicine, Grenada, West Indies
| | - Xheni Deda
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY, USA
| | - Rajarajeshwari Ramachandran
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Vinaya Gaduputi
- Division of Gastroenterology and Hepatology, SBH Health System, Bronx, NY, USA
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6
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Yang S, Liu XL, Guo XL, Song B, Li SZ, Sun XF, Feng Y. Solitary metastasis to the skin and colon from gastric cancer after curative gastrectomy and chemotherapy: A case report. Medicine (Baltimore) 2020; 99:e21532. [PMID: 32756202 PMCID: PMC7402901 DOI: 10.1097/md.0000000000021532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Gastric cancer usually spread via blood circulation to liver, lung, bone, and kidney after recurrence, but it is extremely rare in clinical practice that gastric carcinoma metastasizes to the skin and colon without metastasis to common sites like liver or lung. PATIENT CONCERNS A 57-year-old man was admitted to the hospital with altered bowel habit and hematochezia for 2 weeks. DIAGNOSES The patient was diagnosed with advanced gastric cancer at stage IIIA (pT3N2M0) two and a half years ago. Cutaneous metastasis from gastric cancer was confirmed by cutaneous biopsy 2 years following curative gastrectomy. Unfortunately, colonic metastasis from gastric cancer was found by PET-CT 6 months after the diagnosis of cutaneous metastasis. INTERVENTIONS The patient was given chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for the skin metastasis. Right hemicolectomy was performed when the malignant tumor of the colon was found, in order to relieve the symptom, and improve the quality of life. OUTCOMES The patient was treated with chemoradiotherapy in a local hospital, the peritoneal carcinomatosis occurred 5 months after the second operation, and died 9 months after the diagnosis of colonic metastasis. LESSONS Our case represents a rare condition that solitary cutaneous and colonic metastasis from gastric cancer can occur after surgical resection and systemic chemotherapy. Its unique clinicopathological features can extend our insights on gastric cancer, and it may provide clinicians with some positive clinical experience for identifying and treating this disease.
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Affiliation(s)
| | - Xiang-Liang Liu
- Cancer Center, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiang-Ling Guo
- Department of Gastroenterology, Jilin Province People's Hospital
| | - Bin Song
- Department of Gastrointestinal colorectal and anal surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | | | | | - Ye Feng
- Department of Gastrointestinal colorectal and anal surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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7
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Clinical Characteristics and Prognosis of Gastrointestinal Metastases in Solid Tumor Patients: A Retrospective Study and Review of Literatures. Anal Cell Pathol (Amst) 2019; 2019:4508756. [PMID: 31929965 PMCID: PMC6939450 DOI: 10.1155/2019/4508756] [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: 08/28/2019] [Accepted: 10/18/2019] [Indexed: 01/11/2023] Open
Abstract
Background According to the literature and our experience, patients with gastrointestinal metastases are relatively rare. Numerous case reports and literature reviews have been reported. We present one of the larger case series of gastrointestinal metastases. Objectives To explore the clinical characteristics and prognosis of patients with gastrointestinal tract metastases, which are rare metastatic sites. Methods Patients with gastrointestinal metastases in the setting of stage IV primary carcinomas treated at Beijing Ditan Hospital and Peking University International Hospital from November 1992 to August 2017 were included in this study. The diagnosis of gastrointestinal tract metastases was based on histopathology. Results 30 patients (median age 56 years, 56.7% female) were included. The most common primary carcinomas associated with gastrointestinal metastases were breast (11 patients, 36.7%), stomach (9 patients, 30.0%), and lung (4 patients, 13.3%) cancer. The major pathological types were adenocarcinoma (16 patients, 53.3%) and ductal carcinoma (9 patients, 30.0%). Ten patients (33.3%) underwent local gastrointestinal treatment, and 20 patients (66.7%) underwent nonlocal treatment (involving chemotherapy alone or best supportive care). For breast cancer patients and gastric cancer patients who underwent local therapy, a significant survival advantage was observed (p = 0.001 and p = 0.012, respectively). The presence of other common metastases was identified as an independent poor prognostic factor through multivariate analysis with a HR (hazard ratio) of survival of 0.182 (95% confidence interval (CI) 0.11-0.523, p = 0.031). Conclusion Gastrointestinal metastases are most frequently from breast invasive ductal carcinoma. The presentation of other common metastases with gastrointestinal metastasis indicates poor prognosis, and selected patients may benefit from surgical intervention.
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8
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Elghali MA, Fadhl H, Hamila F, Mestiri S, Jarrar MS, Letaief R. Colon Metastasis, 8 years after Gastrectomy, for Stage I Gastric Cancer. J Gastrointest Cancer 2019; 50:127-129. [PMID: 28660526 DOI: 10.1007/s12029-017-9976-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Mohamed Amine Elghali
- Department of General Surgery, Farhat Hached University Hospital, Sousse, Tunisia. .,University of Medicine, Sousse, Tunisia.
| | - Houssem Fadhl
- Department of General Surgery, Farhat Hached University Hospital, Sousse, Tunisia.,University of Medicine, Sousse, Tunisia
| | - Fehmi Hamila
- Department of General Surgery, Farhat Hached University Hospital, Sousse, Tunisia.,University of Medicine, Sousse, Tunisia
| | - Sarra Mestiri
- Department of Anatomopathologie, Farhat Hached University Hospital, Sousse, Tunisia
| | | | - Rached Letaief
- Department of General Surgery, Farhat Hached University Hospital, Sousse, Tunisia.,University of Medicine, Sousse, Tunisia
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9
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Galanopoulos M, Gkeros F, Liatsos C, Pontas C, Papaefthymiou A, Viazis N, Mantzaris GJ, Tsoukalas N. Secondary metastatic lesions to colon and rectum. Ann Gastroenterol 2018; 31:282-287. [PMID: 29720853 PMCID: PMC5924850 DOI: 10.20524/aog.2018.0244] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022] Open
Abstract
Metastatic lesions of the colon are a rare clinical entity that may present difficulties in management. The incidence of these metastases appears to be increasing, as a result of physicians' greater awareness during follow-up investigations of a primary neoplasm. Furthermore, the presence of a greater proportion of these abnormalities at autopsy should be a triggering factor for further investigation for doctors dealing with colorectal oncology. Their clinical presentation may vary from asymptomatic to signs similar to those of colorectal cancer. However, immunohistological analysis is considered the cornerstone for differentiating metastases to the colon, originating from other primaries, from primary colorectal neoplasms. Survival reports and treatment options vary. This article concisely presents the main characteristics of the secondary lesions to the colon from neoplasms that metastasize to the large intestine (namely, lung, ovary, breast, prostate, kidney, and melanoma) focusing on their incidence, their clinical presentation and the workup investigation. Physicians aware of this uncommon entity are much better prepared to apply an efficient diagnosis and workup, as well as an appropriate treatment strategy.
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Affiliation(s)
- Michail Galanopoulos
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Filippos Gkeros
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Christos Liatsos
- Department of Gastroenterology, 401 General Military Hospital of Athens (Christos Liatsos), Athens, Greece
| | - Christos Pontas
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Apostolis Papaefthymiou
- Department of Internal Medicine, 401 General Military Hospital of Athens (Apostolis Papaefthymiou), Athens, Greece
| | - Nikos Viazis
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Gerassimos J Mantzaris
- Department of Gastroenterology and Hepatology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals (Michail Galanopoulos, Filippos Gkeros, Christos Pontas, Nikos Viazis, Gerassimos J. Mantzaris), Athens, Greece
| | - Nikolaos Tsoukalas
- Department of Medical Oncology, Veterans Hospital (417 NIMTS) (Nikolaos Tsoukalas), Athens, Greece
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10
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Su WC, Tsai HL, Wu CC, Tsai SY, Yeh YS, Ma CJ, Wang JY. Two rare cases of synchronous and metachronous colonic metastases in patients with advanced gastric cancer. World J Surg Oncol 2018; 16:21. [PMID: 29386011 PMCID: PMC5793428 DOI: 10.1186/s12957-018-1323-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/23/2018] [Indexed: 02/07/2023] Open
Abstract
Background Patients with advanced gastric cancer (GC) may ultimately die because GC mostly leads to synchronous or metachronous metastasis. However, colonic metastasis of GC is extremely rare. According to a PubMed search of papers published from May 1968 to March 2017, only 21 patients with GC (10 patients from 10 case reports and 11 patients from a retrospective study) have been found to have colonic metastasis. In this report, we present two cases of synchronous and metachronous colonic metastases of advanced GC. Case presentation Two patients with advanced GC received a diagnosis of colonic metastasis based on colonoscopic findings and computed tomography images, and the diagnosis was confirmed through pathological immunohistochemical analysis. Herein, we describe the management and outcomes of these metastases. Conclusions Submucosal swelling and segmental bowel wall thickening observed through colonoscopy in patients with advanced GC might indicate colonic metastasis.
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Affiliation(s)
- Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Lin Tsai
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shan-Yin Tsai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yung-Sung Yeh
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Jen Ma
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Research Center for Natural Products & Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan.
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11
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Patel YA, McCall SJ, Zhang X, Jaffe T, Shimpi RA. Radiographic and endoscopic regression of metastatic gastric cancer to the colon in the setting of 5-aminosalicylic acid use. J Gastrointest Oncol 2017; 7:E88-E92. [PMID: 28078130 DOI: 10.21037/jgo.2016.05.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Colonic metastases from gastric cancer are a rare phenomenon and sparsely reported in the literature. We report a case of a 59-year-old woman who presented with vague abdominal symptoms and initial computer tomography (CT) imaging suggestive of a colonic apple-core lesion with serial colonoscopic biopsies diagnostic of metastatic signet ring cell gastric adenocarcinoma. This case is unique given the evolving CT and endoscopic findings that suggested a regression in colonic wall thickening in the setting of 5-aminosalicylic acid (5-ASA) use prior to histologic diagnosis.
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Affiliation(s)
- Yuval A Patel
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shannon J McCall
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Xuefeng Zhang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Tracy Jaffe
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Rahul A Shimpi
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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12
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Diffuse Signet-Ring Cell Gastric Adenocarcinoma "Linitis Plastica" and Pernicious Anemia: a Rare Association. J Gastrointest Cancer 2016; 43 Suppl 1:S283-5. [PMID: 22760711 DOI: 10.1007/s12029-012-9408-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Uemura N, Kurashige J, Kosumi K, Iwatsuki M, Yamashita K, Iwagami S, Baba Y, Sakamoto Y, Miyamoto Y, Yoshida N, Honda Y, Mikami Y, Baba H. Early gastric cancer metastasizing to the rectum, possibly via a hematogenous route: a case report and review of literature. Surg Case Rep 2016; 2:58. [PMID: 27271470 PMCID: PMC4896888 DOI: 10.1186/s40792-016-0180-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/29/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The most common pattern of recurrence of gastric cancer (GC) is peritoneal dissemination. However, rectal metastasis via hematogenous or lymphatic spread is exceedingly rare. We present a case of a 65-year-old man with an intramucosal GC who developed a rectal recurrence, possibly via a hematogenous route. CASE PRESENTATION A 65-year-old man underwent curative endoscopic submucosal dissections for the intramucosal GCs at the anterior wall of the fornix twice. The third GC at the similar location was treated by radical laparoscopic proximal gastrectomy; microscopic examination revealed well-differentiated tubular adenocarcinoma confined to the lamina propria mucosae (T1aN0M0, stage IA). Follow-up colonoscopy revealed a 30-mm submucosal mass in the rectal wall 2 years later, and a metastasis of gastric origin was suspected histopathologically. After a staging laparoscopy confirmed the absence of findings suggestive of serosal involvement or peritoneal dissemination, including negative peritoneal washing cytology, a laparoscopic low anterior resection with lymph node dissection was performed. Microscopically, the tumor was found to mainly be located in the submucosal layer and showed features of moderately differentiated tubular adenocarcinoma. The serosal surface was free of disseminated tumor. Lymph node metastases were identified. Immunohistochemically, there were foci of carcinoma cells that were positive for cytokeratin 20; however, they were negative for cytokeratin 7. Negative staining for caudal-type homeobox 2, a transcription factor indicating goblet cell differentiation, combined with absence of intramucosal carcinoma in the rectal mucosa, suggested a diagnosis of metastatic adenocarcinoma of gastric origin. The absence of evidence of peritoneal dissemination suggested hematogenous or lymphatic spread. CONCLUSION Although rectal metastasis from GC, particularly when attributable to hematologic or lymphatic metastasis, is very rare, metastatic gastric adenocarcinoma should be considered as a differential diagnosis for patients who present with a rectal tumor and a past history of GC, even if it is an early GC.
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Affiliation(s)
- Norio Uemura
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Junji Kurashige
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Keisuke Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kohei Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasuo Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yumi Honda
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Seow-En I, Seow-Choen F. Intestinal type gastric adenocarcinoma with unusual synchronous metastases to the colorectum and bladder. World J Clin Cases 2015; 3:533-537. [PMID: 26090375 PMCID: PMC4468901 DOI: 10.12998/wjcc.v3.i6.533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/14/2015] [Accepted: 04/14/2015] [Indexed: 02/05/2023] Open
Abstract
A 75-year-old male presented with difficult defecation and increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tomography of the abdomen and pelvis showed extensive lymphadenopathy, a gastric mass and rectal as well as bladder wall thickening with bilateral ureterohydronephrosis. Normal looking serosal surfaces of the bladder and bowel were seen on laparoscopy and a defunctioning ileostomy was created. Gastroscopy revealed a malignant mass while cystoscopy and sigmoidscopy found extensive tumour growth lining the mucosal surfaces. Biopsies from all sites were compatible with intestinal type adenocarcinoma of gastric origin with few signet ring cells. Metabolic response to palliative chemotherapy was good and the patient’s symptoms have improved on follow-up four months post ileostomy. We discuss the immunohistochemical profile of the tumour and review the literature.
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Barral M, Hoeffel C, Boudiaf M, Dohan A, Marteau P, Laurent V, Soyer P. Rectal cancer in inflammatory bowel diseases: MR imaging findings. ACTA ACUST UNITED AC 2015; 39:443-51. [PMID: 24570133 DOI: 10.1007/s00261-014-0103-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To retrospectively analyze the MR imaging features of rectal cancer in patients with inflammatory bowel diseases (IBD). MATERIALS AND METHODS The MR imaging examinations of 13 patients with IBD-related rectal cancer were retrospectively reviewed. MR imaging included T2-weighted, diffusion-weighted (DW), and gadolinium chelate-enhanced MR imaging. MR imaging findings were analyzed and compared with endoscopic and histopathological findings. RESULTS Eight patients (8/13; 62%) had active IBD and five (5/13; 38%) had quiescent IBD on MR imaging. Two different tumor patterns were individualized including clearly visible soft-tissue mass (4/13; 31%) (Type 1 tumor) and marked circumferential rectal wall thickening (9/13; 69%) (Type 2 tumor). Twelve tumors (12/13; 92%) showed high signal intensity on T2-weighted MR images. All six tumors studied with DW-MR imaging (6/6; 100%) showed high signal on DW-MR imaging with restricted diffusion on apparent diffusion coefficient (ADC) map. On gadolinium chelate-enhanced MR imaging, heterogeneous enhancement was observed in one tumor (1/13; 8%), whereas 12 tumors (12/13; 92%) showed homogeneous enhancement. MR imaging showed pelvic fistula and intrapelvic abscess in association with four (4/13; 31%) and two tumors (2/13; 15%), respectively. CONCLUSION Our limited retrospective study demonstrates that rectal cancer in IBD patients can present as a circumferential wall thickening resembling inflammation and can occur in the absence of fistula or abscess. The use of T2-weighted and DW-MR imaging is recommended to improve rectal cancer detection in patients with long-standing IBD.
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Affiliation(s)
- Matthias Barral
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France,
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16
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Oh SY, Cunningham J, Saif MW. Colonic Metastasis From Gastric Cancer. Clin Colorectal Cancer 2014; 13:255-6. [DOI: 10.1016/j.clcc.2014.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/10/2014] [Indexed: 02/08/2023]
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17
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Noji T, Yamamura Y, Muto J, Kuroda A, Koinuma J, Yoshioka T, Murakawa K, Otake S, Hirano S, Ono K. Surgical resection of colorectal recurrence of gastric cancer more than 5 years after primary resection. Int J Surg Case Rep 2014; 5:954-7. [PMID: 25460445 PMCID: PMC4275786 DOI: 10.1016/j.ijscr.2014.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Intestinal metastasis from gastric cancer is rare, although the most common cause of secondary neoplastic infiltration of the colon is gastric cancer. However, little data is available on recurrence or death in patients with gastric cancer surviving >5 years post-gastrectomy. Here we report two cases of lower intestinal metastasis from gastric cancer >5 years after primary resection and discuss with reference to the literature. PRESENTATION OF CASE Case 1: A 61-year-old man with a history of total gastrectomy for gastric cancer 9 years earlier was referred to our hospital with constipation and abdominal distention. We diagnosed primary colon cancer and subsequently performed extended left hemicolectomy. Histological examination revealed poorly differentiated adenocarcinoma resembling the gastric tumor he had 9 years earlier. The patient refused postoperative adjuvant chemotherapy and remained alive with cancerous peritonitis and skin metastases as of 17 months later. Case 2: A 46-year-old woman with a history of total gastrectomy for gastric cancer 9 years earlier presented with constipation. She also had a history of Krukenberg tumor 3 years earlier. We diagnosed metastatic rectal cancer and subsequently performed low anterior resection and hysterectomy. Pathological examination revealed poorly differentiated tubular adenocarcinoma, resembling the gastric tumor. The patient remained alive without recurrence as of 17 months later. DISCUSSION We found 19 reported cases of patients with resection of colon metastases from gastric cancer. Median disease-free interval was 74 months. CONCLUSION Resection of late-onset colorectal recurrence from gastric cancer appears worthwhile for selected patients.
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Affiliation(s)
- Takehiro Noji
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan; Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Yoshiyuki Yamamura
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan
| | - Jun Muto
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan
| | - Aki Kuroda
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan
| | - Junkichi Koinuma
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan
| | - Tatsuya Yoshioka
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan
| | - Katsuhiko Murakawa
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan
| | - Setsuyuki Otake
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Koichi Ono
- Department of Surgery, Obihiro Kosei General Hospital, W7 S8, Obihiro City, Hokkaido 080-0016, Japan
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18
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Laparoscopic low anterior resection for hematogenous rectal metastasis from gastric adenocarcinoma: a case report. World J Surg Oncol 2011; 9:148. [PMID: 22074191 PMCID: PMC3230135 DOI: 10.1186/1477-7819-9-148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 11/11/2011] [Indexed: 02/07/2023] Open
Abstract
Background Gastric cancer is one of the most common malignancies in the world and is the second most common cause of cancer-related death in Korea. Colorectal metastases from gastric adenocarcinoma are known to be very rare. We report an unusual case of rectal metastasis of gastric adenocarcinoma. Case presentation We report a case of a 43-year-old female patient with gastric cancer who first presented with epigastric pain. The endoscopic and radiologic findings were suggestive of Borrmann type III advanced gastric cancer with linitis plastica. Radical total gastrectomy with D2 lymph node dissection was performed. The pathology report was AJCC TNM Stage II gastric adenocarcinoma (T3N0M0). On follow up at 34 months after surgery, the patient complained of difficulty in defecation. On colonoscopy, a hard, indurated extraluminal mass was detected 7 cm proximal to the anal verge. The biopsy demonstrated chronic nonspecific colitis. Abdominal CT, rectal MRI and PET-CT revealed rectal metastasis from gastric cancer. Laparoscopic ultralow anterior resection with diverting ileostomy was performed. The pathology report was metastatic adenocarcinoma, and this diagnosis was identical to the gastric pathology reported in the previous pathology report. The patient was discharged after the 11th postoperative day with no adverse events. Conclusion Rectal metastasis from gastric cancer is known to be very rare. However, metastatic gastric adenocarcinoma should be considered as a differential diagnosis for patients presenting with a colorectal mass and a past history of gastric cancer.
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19
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Pace U, Contino G, Chiappa A, Bertani E, Bianchi PP, Fazio N, Renne G, Di Meglio G, Andreoni B. Metachronous Colon Metastases from Gastric Adenocarcinoma: A Case Report. Case Rep Oncol 2009; 2:92-96. [PMID: 20740169 PMCID: PMC2918854 DOI: 10.1159/000215945] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The colon is a very rare metastatic localization. Here we report a case of colonic metastases from gastric adenocarcinoma whose clinical presentation was suggestive of a de novo adenocarcinoma of the ascending colon. The authors discuss that in the presence of a previous history of gastric cancer, immunohistochemical analysis on endoscopic biopsies may help in the definition of a differential diagnosis. Furthermore, this rare metastatic localization might suggest a poor prognosis and a more accurate diagnostic work-up.
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Affiliation(s)
- Ugo Pace
- Division of General and Laparoscopic Surgery, European Institute of Oncology, Milan, Italy
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20
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Dresen RC, Beets GH, Vliegen RFA, Creytens DHKV, Beets-Tan RGH. Linitis plastica of the rectum secondary to bladder carcinoma: a report of two cases and its MR features. Br J Radiol 2008; 81:e249-51. [PMID: 18796553 DOI: 10.1259/bjr/59924178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rectal linitis plastica (RLP) is a circumferentially infiltrating intramural anaplastic carcinoma that results in a rigid constricted rectum with thickened walls. A long delay between the onset of symptoms and the diagnosis often occurs because RLP can mimic a lot of diseases and endoscopy and biopsies are often negative, owing to the fact that the mucosa is frequently unaffected in RLP. RLP secondary to bladder cancer is rarely described in the English literature. We present the first report of the MR features of secondary rectal linitis plastica from a bladder carcinoma. Two patients presented with changed bowel habits. All diagnostic tests were inconclusive. In both patients, pelvic T(2) weighted MR images revealed a double-layered thickening of the rectal wall with an inner isointense circumferential thickening of the submucosa and outer hypointense circumferential thickening of the muscular rectal wall. Based on MRI, further investigations were performed and secondary RLP was diagnosed. It is important to establish the diagnosis of RLP early because of its bad prognosis. The value of MRI in supporting the diagnosis of RLP should not be underestimated. As endoscopy plus biopsy can often be negative, we suggest that, if pelvic MRI shows a concentric double layered thickening of the rectal wall over a long segment, then the diagnosis of RLP should be considered. This should prompt further investigations either to confirm or rule out the diagnosis of RLP by performing endoscopy with deep rectal wall biopsies.
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Affiliation(s)
- R C Dresen
- Department of Radiology, University Hospital of Maastricht, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.
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21
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Abstract
A 66-year-old Japanese woman presented with intestinal obstruction and right-sided hydronephrosis. Although upper gastrointestinal endoscopy demonstrated signet-ring cell gastric carcinoma, colonoscopy and barium enema study yielded findings mimicking Crohn's disease in the colon, that is, skipping longitudinal ulcer scarlike strictures, cobblestone appearance, segmental stricture, and pseudosacculations. After total gastrectomy and right-sided hemicolectomy, the final diagnosis of gastric cancer extensively involving the colon, and not of Crohn's disease complicating gastric cancer, was established. Pathologic examination showed that anaplastic cancer with exuberant desmoplastic reaction and infiltration along the mesenteric border principally accounted for the morphological similarities noted between Crohn's disease and metastatic colon cancer in this case. The findings in the present case, together with a review of the literature, suggest that metastatic colon cancer should be considered when Crohn-like colonic findings are encountered, not only in individuals with concurrent cancer in other sites but also in those with distant history of cancer.
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22
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Rodríguez Ortega M, Carabias Hernández A, Rodríguez Barbero JM, Garaulet González P, Limones Esteban M. [Intestinal linitis plastica: late metastasis from gastric signet ring cell adenocarcinoma]. Cir Esp 2006; 80:171-3. [PMID: 16956554 DOI: 10.1016/s0009-739x(06)70947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Linitis plastica is a malignant disease that usually occurs in the stomach, although it can affect any segment of the alimentary tract. Typically, this entity shows slow progression and insidious clinical course. We present the case of a patient with a previous diagnosis of signet ring cell cancer of the stomach that had been treated with curative intent 12 years before the clinical onset of small and large bowel linitis plastica. The diagnosis was obtained as an incidental pathological finding after urgent surgery for intestinal obstruction. No gastric mass was found. Linitis plastica should be considered in the differential diagnosis of patients with symptoms of obstruction after resection of a gastric carcinoma, especially if there are macroscopic surgical findings of circumferential narrowing. A long interval after diagnosis and treatment of the primary disease does not allow malignancy to be ruled out.
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Affiliation(s)
- María Rodríguez Ortega
- Servicio de Cirugía General y Digestivo, Hospital Universitario de Getafe, Madrid, España.
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23
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Achneck HE, Pradhan SK, Kavic SM, Longo WE. Primary signet-ring cell carcinoma mimicking segmental Crohn's colitis. Dig Liver Dis 2005; 37:537-41. [PMID: 15975543 DOI: 10.1016/j.dld.2004.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 12/25/2004] [Indexed: 12/11/2022]
Abstract
Primary signet-ring cell carcinoma of the colon is a rare entity with a dismal prognosis, mainly due to a delay in diagnosis. Here, we present a case of a 30-year-old Filipino woman who presented with symptoms mimicking inflammatory bowel disease. A barium enema and colonoscopy demonstrated a stricture in the rectosigmoid region. A biopsy revealed granulomatous changes indicative of inflammatory bowel disease. Despite initial improvement of her symptoms on total parenteral nutrition and steroids, the patient relapsed several weeks later with recurrent left lower quadrant pain. A subsequent biopsy revealed poorly differentiated signet-ring cell carcinoma of the colon. She was treated surgically with a left hemi-colectomy and primary repair. A high degree of suspicion is necessary to correctly diagnose these, often young, patients with primary signet-ring cell carcinoma early and have a positive impact on survival. The literature on primary signet-ring cell carcinoma is reviewed.
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Affiliation(s)
- H E Achneck
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06520-8062, USA
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24
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Lee HC, Yang MT, Lin KY, Tu HY, Zhang TA, Chen PH. Metastases from gastric carcinoma to colon in the form of multiple flat elevated lesions: a case report. Kaohsiung J Med Sci 2005; 20:552-7. [PMID: 15620119 DOI: 10.1016/s1607-551x(09)70257-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Gastric carcinoma is a common malignancy worldwide. Advanced stages of the disease may result in metastases to many other organs of the body. However, colonic metastases are rare. We report a case of gastric carcinoma with symptoms of abdominal fullness and weight loss. The serum carcinoembryonic antigen level was elevated. Esophagogastroduodenoscopy revealed giant folds occupying the whole gastric body and poor expansion of the stomach. Histologic examination of biopsy specimens from the giant fold demonstrated poorly differentiated adenocarcinoma with signet ring-cell differentiation. Total colonoscopy revealed five or six discrete flat elevated lesions in the distal transverse, descending, and sigmoid colons. These lesions were characterized by a clear margin of 3-5 mm in diameter and erosions on the tips. Polypectomy specimens demonstrated signet ring-cell carcinoma, which was histologically similar to the specimens taken from the gastric lesion. We conclude that this was a rare case in which gastric signet ring-cell carcinoma had metastasized to the colon in the form of flat elevated lesions, combined with rapid and wide lymphatic spread to the thorax and abdomen in a clinical course as short as 46 days.
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Affiliation(s)
- Hsi-Chang Lee
- Division of Internal Medicine, Taipei Municipal Jen-Ai Hospital, Taipei, Taiwan.
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25
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Affiliation(s)
- P Karila-Cohen
- Département d'Imagerie FMP, 24 rue Saint Victor 75005 Paris, France.
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26
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Sempere L, Aparicio JR, Jover R, Casellas JA, Poveda MJ, Alonso G, Pérez-Mateo M. [Primary linitis plastica of the rectum]. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:68-70. [PMID: 15710085 DOI: 10.1157/13070703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Linitis plastica of the rectum is an uncommon entity that is difficult to diagnose due to the lack of mucosal lesions on endoscopy, the low diagnostic yield of biopsy and non-specific findings of barium radiology and computerized tomography. Rectal endoscopic ultrasonography has had a radical impact on the differential diagnosis of stenosing lesions of the rectum, among them linitis plastica, allowing diagnosis of this lesion even in patients with negative results of biopsy.
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Affiliation(s)
- L Sempere
- Sección de Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
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27
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Harisinghani MG, Wittenberg J, Blake MA, Chen S, Jhaveri K, Mueller PR. Halo sign: useful CT sign for differentiating benign from malignant colonic disease. Clin Radiol 2003; 58:306-10. [PMID: 12662952 DOI: 10.1016/s0009-9260(02)00520-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the halo sign for accurately distinguishing benign from malignant colonic wall thickening. MATERIALS AND METHODS Computed tomography (CT) examinations of 92 patients (70 men; 22 women; mean age 57 years) with pathologically proven colonic wall thickening (51 benign and 41 malignant) were retrospectively reviewed in a blinded fashion. The affected segment was assessed for presence of the halo sign, degree and uniformity of thickness and density of the intramural stratum. RESULTS The halo sign was present in 74.5% (38/51) patients with benign and 7.3% (3/41) patients with malignant bowel disease. The presence of the halo sign was 75.4% sensitive and 92.5% specific for benign bowel wall thickening. All 38 benign halos showed uniform, continuous stratification; only one of three malignant halos met the strict criteria for benign halo. CONCLUSION The halo sign is a moderately sensitive and highly specific sign for distinguishing benign from malignant bowel wall thickening. However, it is not pathognomonic for benign disease. Detailed analysis of halo characteristics is necessary to improve the usefulness of this finding.
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Affiliation(s)
- M G Harisinghani
- Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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28
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Kim KA, Park CM, Park SW, Cha SH, Seol HY, Cha IH, Lee KY. CT findings in the abdomen and pelvis after gastric carcinoma resection. AJR Am J Roentgenol 2002; 179:1037-41. [PMID: 12239061 DOI: 10.2214/ajr.179.4.1791037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kyeong Ah Kim
- Department of Radiology, Medical Science Research Center, Korea University Guro Hospital, 80, Guro-Dong, Guro-Ku, Seoul 152-050, Korea
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29
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IWABUCHI MASAHIRO, HIWATASHI NOBUO, SUZUKI TATSUHIKO, TESHIMA SHIN, SAITO TOSHIHIRO, SUZUKI HIROYOSHI, MORI YOSHIMASA, ISHIBASHI JUNICHI, CHIDA NOBUYUKI, TADOKORO KEIICHI. Multiple depressed‐type colonic cancer (IIC)‐like configurations: metastases from gastric cancer. Dig Endosc 2002. [DOI: 10.1046/j.1443-1661.2002.00171.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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