Gastric adenocarcinoma presenting with multiple skeletal muscle metastases

Abstract

A 42-year-old man presented to the gastroenterology clinic with features of gastric outlet obstruction, significant weight loss, anaemia, ascites, and pain in the lower back and left thigh. CT scan of the abdomen and pelvis showed wall thickening in the antropyloric region of the stomach and enhancing soft tissue lesion in the left psoas and right gluteal region. Gastroscopy revealed a circumferential growth in the antrum and pylorus of the stomach, and biopsy from the growth was reported as moderately differentiated adenocarcinoma. Positron emission tomography-CT scan showed multiple skeletal muscle metastases all over the body. Fine-needle aspiration cytology and immunohistochemistry from the psoas lesion confirmed metastatic adenocarcinoma deposits. He underwent antropyloric stenting for his obstructive symptoms and received supportive care, finally succumbed to his illness after 6 weeks.

Keywords: Gastric cancer; Palliative care; Pathology.

Figure 1

Contrast-enhanced CT scan of the abdomen showing (A) circumferential wall thickening in the antropyloric region of the stomach, (B) enhancing soft tissue lesion in the left psoas muscle.

Figure 2

Gastroscopy image showing circumferential growth in the antropyloric region of the stomach.

Figure 3

Photomicrographs of gastric biopsy showing (A) tumour cells arranged in nests with moderate pleomorphism and hyperchromatic nuclei (H&E stain, 20×), (B) tumour cells arranged in cords infiltrating the muscularis mucosa (H&E stain, 20×).

Figure 4

Positron emission tomography-CT images: (A) maximum intensity projection image showing multiple enhancing soft tissue deposits in left supraspinatus, subscapularis, biceps brachii, paraspinal muscles, thigh and right gluteus maximus muscles; (B–D) axial images showing enhancing lesions in left biceps brachii, left psoas and right gluteus maximus muscles, respectively.

Figure 5

Photomicrographs of fine-needle aspiration cytology from psoas muscle showing: (A) tumour cells in clusters (May-Grunwald-Giemsa stain, 20×), (B) single cluster of tumour cells with moderate nuclear pleomorphism, (Papanicolaou stain, 40×), (C) cell block slide with a cluster of tumour cells, (H&E stain, 40×), (D) immunohistochemistry showing cytokeratin-7 positivity of tumour cells, 40×.