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Review
. 2021 Mar 20;19(1):83.
doi: 10.1186/s12957-021-02191-9.

Isolated brachioradialis metastasis of gastric adenocarcinoma after R0 resection

Elizabeth Jacob  1 , Levi Smucker  2 , Ryan Crouse  1 , Ayana Allard-Picou  1   3
Affiliations
Review

Isolated brachioradialis metastasis of gastric adenocarcinoma after R0 resection

Elizabeth Jacob et al. World J Surg Oncol. .

Abstract

Background: Gastric cancer is the fifth most common cancer worldwide, with an incidence of 6.72 per 100,000 people. Thirty-two percent of gastric cancer patients will live 5 years after diagnosis. Single-site metastasis is noted in 26% of patients with gastric cancer, most commonly in the liver (48%), peritoneum (32%), lung (15%), and bone (12%). Here, a case is presented in which a single skeletal muscle metastasis appeared after appropriate resection and treatment.

Case presentation: A 63-year-old man underwent neoadjuvant chemotherapy and a multivisceral en bloc R0 resection. Final pathology showed no evidence of lymph node metastasis with 31 negative lymph nodes. Four months postoperatively, the patient was found to have a rapidly growing biopsy-proven extremity soft tissue gastric metastasis within the brachioradialis muscle. He subsequently underwent metastasectomy and immunotherapy.

Conclusion: This case is a rare example of an isolated extremity metastasis of gastric adenocarcinoma in the setting of an R0 resection of the primary tumor and negative nodal disease on final pathology, suggestive of hematogenous spread. We review the biology, workup, and management of gastric cancer and highlight new advancements in the treatment of this aggressive cancer.

Keywords: D2 lymphadenectomy; Gastric cancer; Metastatic cancer; Tumor biology.

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Conflict of interest statement

The authors have no competing interests or financial interest in the publication as presented.

Figures

Fig. 1
Fig. 1
Initial endoscopic appearance of ulcerated mass in gastric fundus (a). Preoperative contrast-enhanced CT scan of the abdomen and pelvis (b). Yellow arrows demonstrate mass in gastric fundus and body
Fig. 2
Fig. 2
Initial appearance of gastric cancer prior to treatment, staining negative for Uroplakin II and weak for GATA-3
Fig. 3
Fig. 3
H&E stain showing gastric tumor with necrosis, indicating response to neoadjuvant chemoradiotherapy. a Necrotic tumor as evidence of neoadjuvant treatment effect. b Viable tumor
Fig. 4
Fig. 4
MRI and PET scan imaging of right elbow mass, 4 months post-operatively
Fig. 5
Fig. 5
Post-metastasectomy surveillance PET scan demonstrating FDG avid right axillary lymph node (a) and resolution of FDG avidity as well as decrease in size of this node (b) following immunotherapy, indicating response to immunotherapy. This response persisted on subsequent PET scans and the patient remains disease free at 1 year after diagnosis of metastatic disease
Fig. 6
Fig. 6
EGD at 11 months after initial resection demonstrating no evidence of local recurrence at the esophagojejunostomy anastomosis
See this image and copyright information in PMC

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