2722 Thinking With the Gut: An Unfortunate Case of Metastatic Gastric Cancer

Abstract

INTRODUCTION: Metastatic brain tumors represent 20-40% of intracranial neoplasms [Table 1]. Although rare, the incidence of brain metastasis from the gastrointestinal (GI) tract has increased likely secondary to prolonged survival of patients with GI cancers. Symptoms of metastatic spread parallels space-occupying lesions in brain: confusion, headache, visual disturbances, nausea, vomiting, altered mental status, gait abnormalities, seizures, and decreased consciousness. Current literature estimates 0.63% of gastric adenocarcinoma (GA) cases metastasize to the brain1. Here, we present an unusual case of metastatic brain spread of GA. CASE DESCRIPTION/METHODS: 59-year-old male with history of hypertension, tobacco use, GERD, and gastric cancer who presented with a one-week history of headaches, nausea and vomiting, and decreased visual acuity. His gastric cancer had previously been treated with neoadjuvant chemotherapy, radiation and partial esophagectomy with repeat screening via computed tomography (CT). A CT of his head showed vasogenic edema in the right frontal lobe, raising concern for metastatic disease versus primary CNS lesion [Figure 1]. A magnetic resonance imaging (MRI) brain showed an enhancing mass in the anterior-inferior right frontal lobe with metastatic disease as well as leptomeningeal carcinomatosis [Figure 2]. He underwent right frontal burr-hole for stereotactic biopsy of the right frontal tumor. Pathology was consistent with metastatic adenocarcinoma. He was started on IV steroids and began whole brain radiation therapy. He was not a surgical candidate and was unstable for chemotherapy. His family transitioned him to comfort care measures after which he shortly passed. DISCUSSION: Gastric cancer is the fourth most common cancer worldwide and the second most common cause of cancer-related death. Current literature estimates GA incidence rate to be 6.7/100,000 persons with a mortality rate of 3.4/100,000 persons in the United States. Risk factors include H. pylori, male sex, Asian/Pacific island ethnicity, obesity, smoking, and a diet rich in smoked, salted, pickled foods. Our patient demonstrated an unusual case of metastatic GA without evidence of visceral metastases. His case was further complicated as he had screening CT scans at six month intervals which had been within normal limits until his presentation. His case unfortunately demonstrates the ominous prognosis of patients with brain metastasis, prompting the need for increased surveillance and brain imaging.