Solitary metastasis to the skin and colon from gastric cancer after curative gastrectomy and chemotherapy: A case report

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.

Figure 1

A: The poorly differentiated adenocarcinoma of the stomach characterized by signet-ring cell carcinoma and mucinous adenocarcinoma (H&E × 200); B: The infiltration of the skin by poorly differentiated adenocarcinoma that originated from gastric cancer (H&E × 200).

Figure 2

A: Abdominal CT revealed the lumen stenosis and the uneven thickening of the ascending colon and ileocecal region. B: Colonoscopy revealed that the surface of the ileocecal valves was rough and uneven, and the ascending colon presented as an annular stricture. C: FDG-PET/CT examination: This indicated a slightly abnormal 18F-FDG uptake at the adipose layer of the nape and bilateral scapular region, and the right hemicolon after chemotherapy.

Figure 3

Histological examination of the colon cancers derived from gastric cancer metastasis. This revealed the poorly differentiated adenocarcinoma with signet ring cell carcinoma in the colon mucosa. A: low magnification of the colon tumor section (H&E × 40); B: high magnification of the colon tumor section (H&E × 200).

Figure 4

Immunohistochemistry of gastric tumors, skin tumors, and colon tumors. This revealed that both the primary site and metastatic sites have similar patterns of cytokeratin expression, but different Ki67 expression levels and HER-2 status. A: primary site; B: cutaneous metastasis; C: colonic metastasis. (all, H&E × 200).