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Yao GL, Tao YJ, Fan YG. Cutaneous metastasis from gastric cancer: Manifestation, diagnosis, treatment and prognosis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 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] [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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Tian L, Ye ZB, Du YL, Li QF, He LY, Zhang HZ. Inflammatory cutaneous metastases originating from gastric cancer: A case report. World J Clin Cases 2023; 11:8411-8415. [PMID: 38130616 PMCID: PMC10731189 DOI: 10.12998/wjcc.v11.i35.8411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/22/2023] [Accepted: 12/04/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Cutaneous metastasis with gastric cancer (GC) origin is extremely rare and associated with poor prognosis. Nodular type is the most common type, while other forms are extremely rare. CASE SUMMARY This study describes severe skin redness, swelling, pain, and fever in a 65-year-old man diagnosed with GC, whose left chest wall, left upper limb, and left back were mainly affected. Firstly, the patient was diagnosed with "lymphangitis" and treated to promote lymphatic return. However, the symptoms were constantly deteriorating, and skin thickening and scattered small nodules gradually appeared. Finally, the skin biopsy confirmed cutaneous metastases, and the patient died 7 d later. CONCLUSION Our case highlights that cutaneous metastasis should be considered when skin lesions appear in patients with GC.
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Affiliation(s)
- Lei Tian
- Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Zhi-Bin Ye
- Department of Gastrointestinal Surgery, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Yun-Lei Du
- Department of Emergency, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Qiao-Fang Li
- Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Li-Ya He
- Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Hong-Zhen Zhang
- Department of Oncology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
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Wang B, Chen J, Wang Y, Dong LL, Shen GF. Edema of limbs as the primary symptom of gastric signet-ring cell carcinoma: A case report and literature review. World J Gastrointest Oncol 2022; 14:2404-2414. [PMID: 36568945 PMCID: PMC9782619 DOI: 10.4251/wjgo.v14.i12.2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/17/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Metastatic skin cancers are relatively rare dermatological malignancies. They usually present as nodules, erythematous lesions, scar-like lesions or other lesion types. Signet-ring cell carcinoma (SRCC) is an uncommon histological type of gastric cancer that usually behaves aggressively and has a poor prognosis. Skin metastasis may be the first sign of clinically silent visceral cancer or recurrence of an internal malignancy.
CASE SUMMARY Herein we report on the case of a 55-year-old man with edema of a lower extremity as the primary symptom which progressed from local to generalized pitting edema in the year following skin involvement. Pathological evidence from gastroscopic specimens and subcutaneous tissue biopsy showed typical signet-ring cells and gland-like structures. Consistently, immunohistochemical analysis revealed positive pan-cytokeratin expression in tumor cells. A diagnosis of gastric SRCC with skin metastasis was established. Moreover, lymphoscintigraphy showed an obvious accumulation of radiotracer on the anterior and posterior sides of the right leg which indicated lymphedema. We reviewed the relevant literature on subcutaneous metastases of gastric SRCC.
CONCLUSION This rare case emphasizes the importance of physical examination as it may help elucidate the etiology of edema.
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Affiliation(s)
- Bei Wang
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jing Chen
- Division of Cardiology, Department of Internal Medicine and Gene Therapy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ying Wang
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Ling-Li Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Gui-Fen Shen
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Hao Z, Deng Y, He Y, Xiong X. Signet-Ring Cutaneous Metastasis Presenting with Huge Bunches of Grapes. Clin Cosmet Investig Dermatol 2022; 15:1997-2001. [PMID: 36172248 PMCID: PMC9512062 DOI: 10.2147/ccid.s378478] [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: 06/17/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022]
Abstract
Signet-ring cell (SRC) is a histologic type in which cells show unique features under the microscope. We mainly found signet-ring cells (SRCs) in gastrointestinal and breast tumors. Cutaneous metastasis from internal carcinomas was an uncommon presentation. The cases of signet-ring cell carcinoma (SRCC) metastasis to the skin were rarely reported. Cutaneous metastasis indicated a poor prognosis for a patient. Here, we report a female who had huge grape-like nodules arising from gastrointestinal SRCC in her trunk and thigh.
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Affiliation(s)
- Zhenyu Hao
- Department of Dermatology STD, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Yongqiong Deng
- Department of Dermatology STD, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Yuanmin He
- Department of Dermatology STD, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Xia Xiong
- Department of Dermatology STD, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
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Demircioğlu D, Öztürk Durmaz E, Demirkesen C, Şahin S. Livedoid cutaneous metastasis of signet-ring cell gastric carcinoma. J Cutan Pathol 2021; 48:785-788. [PMID: 33476049 DOI: 10.1111/cup.13969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/26/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
Cutaneous metastasis of gastric cancer is extremely rare. Nodular forms are more common and inflammatory forms are exceptionally encountered. Herein, we report a case of inflammatory cutaneous metastasis of signet-ring cell gastric cancer (poorly cohesive gastric carcinoma with signet-ring cell component) masquerading as livedo reticularis. To our knowledge, such a clinical presentation of cutaneous metastasis has not been reported for gastric cancer. It is imperative to preserve a high index of clinical suspicion for diagnosing cutaneous metastases. Our case highlights the importance of obtaining a skin biopsy in patients with a known history of internal malignancy. Bizarre, newly erupting, evolving, persistent, or treatment-refractory dermatologic lesions (such as nodules, ulcers, erythematous, reticular, or livedoid patches) might be clues for an underlying internal malignancy and require prompt histopathological sampling. Personal medical history, histopathological examination, and immunohistochemical profiling are equally important in distinguishing primary cutaneous carcinomas from secondary metastatic deposits. Early recognition of a cutaneous metastasis might enable appropriate staging and timely intervention, thereby prolonging survival.
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Affiliation(s)
- Deniz Demircioğlu
- Department of Dermatology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Emel Öztürk Durmaz
- Department of Dermatology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Cüyan Demirkesen
- Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Sedef Şahin
- Department of Dermatology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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Gilbert JD, Langlois NEI, Ruszkiewicz A, Moffat D, Cash K. Signet-ring cell appearance of atrophic fat cells. Forensic Sci Med Pathol 2020; 17:141-143. [PMID: 32789763 DOI: 10.1007/s12024-020-00292-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
Cells with 'signet-ring' appearance were found at post-mortem examination of a man with a history of chronic illness, weight loss and multiple regions of 'bowel thickening' during life. Due to the decedent's history, the finding raised the possibility of disseminated signet-ring adenocarcinoma. However, the vacuoles did not stain for mucin and the cells did not stain for keratin. The cells did stain for calretinin and so a diagnosis of signet ring mesothelioma was considered. However, it was suggested that the cells with a cytoplasmic vacuole displacing the nucleus to one side producing the signet-ring appearance were instead atrophic fat cells. This was subsequently proven by Oil Red O staining.
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Affiliation(s)
- John D Gilbert
- Forensic Science SA, GPO Box 2790, Adelaide, South Australia, 5001, Australia
| | - Neil E I Langlois
- Forensic Science SA, GPO Box 2790, Adelaide, South Australia, 5001, Australia. .,School of Medical and Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - Andrew Ruszkiewicz
- School of Medical and Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Anatomical Pathology, SA Pathology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Moffat
- Anatomical Pathology, SA Pathology, Flinders Medical Centre, Bedford Park, South Australia
| | - Kathy Cash
- Anatomical Pathology, SA Pathology, Frome Rd, Adelaide, South Australia, Australia
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Yeniocak A, Çamlı MF, Geçer M, Yildiz K. Nodule on scalp: As a metastatic gastric cancer. Dermatol Ther 2020; 33:e13886. [PMID: 32578321 DOI: 10.1111/dth.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/14/2020] [Accepted: 06/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ali Yeniocak
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Fatih Çamlı
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Melin Geçer
- Department of Pathology, Bezmialem Vakif University, Istanbul, Turkey
| | - Kemalettin Yildiz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmialem Vakif University, Istanbul, Turkey
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Souza BDS, Bonamigo RR, Viapiana GL, Cartell A. Signet ring cells in carcinomatous lymphangitis due to gastric adenocarcinoma. An Bras Dermatol 2020; 95:490-492. [PMID: 32487420 PMCID: PMC7335879 DOI: 10.1016/j.abd.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Cutaneous metastases are rare. They usually present as nodules or tumors. Diagnosis is based on histopathological examination and prognosis is unfavorable. This report describes the case of a female patient, 72 years old, with surgically treated gastric antrum adenocarcinoma. Pathology showed poorly differentiated adenocarcinoma with signet ring cells. It evolved with bone involvement, lymph node enlargement in the inguinal region, and skin infiltration in the lower limbs, abdomen, and root of the upper limbs. Skin biopsy demonstrated signet ring carcinoma embolizing the dermal and hypodermic vessels and invasion of adipose tissue, confirming carcinomatous lymphangitis. Carcinomatous lymphangitis is the cutaneous and subcutaneous lymphatic invasion by tumor cells. Cutaneous metastasis is relatively uncommon and presents mainly as cutaneous or subcutaneous nodules, and more rarely as inflammatory lesions. The present case reports carcinomatous lymphangitis associated with gastric cancer.
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Affiliation(s)
| | | | | | - André Cartell
- Department of Pathology, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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