Gastric cancer presenting with solitary gigantic pelvic metastasis

Abstract

Bone metastasis of gastric cancer is relatively uncommon in clinical practice. Moreover, it is all the more unusual for the primary presentation of gastric malignancy to be bone metastasis. Here, we describe a male patient who complained of pain and edema in his right lower extremity. Further assessment by computed tomography and positron emission tomography revealed an abnormally thickened gastric cardia and a giant neoplasm in the right pelvis with bone damage. Consequently, the finding of adenocarcinoma cells in pelvic and cardia biopsy specimens contributed to the diagnosis of pelvic metastasis from gastric cancer. This case report illustrates that stomach cancer has the potential, although far less than breast, prostate and lung cancers, to metastasize to bone. In addition, it highlights the peculiarity of this bone metastasis which is pelvic, solitary and huge.

Keywords: bone metastasis; gastric cancer; pelvic.

Fig. 1. Pelvic metastasis of the cardia adenocarcinoma in a 49-year-old man.

Axial unenhanced CT shows a thickened mass (arrow) in the cardia area (A) and an irregular-form soft tissue lump (arrow) in the right pelvis with osteolytic destructions of the right iliac bone (B). PET image exhibits high radioactive uptake (arrow) (C) and demonstrates ring-shaped high radioactive uptake (arrow) of the right pelvic mass (D).

Fig. 2. Pathological examination (H&E×400).

A: Histology of gastric cardia biopsies reveals squmous epithelium infiltrated with moderately differentiated adenocarcinoma cells, Grade II. B: Metastatic adenocarcinoma cells are evident microscopically in pelvis mass.