Metastatic Gastric Signet Ring Cell Adenocarcinoma Presenting With Colonic Stenosis.

Jurij Hanzel,Marija Ribnikar,Branislava Ranković

doi:10.7759/cureus.8420

Jurij Hanzel, Marija Ribnikar + Show 1 more

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https://doi.org/10.7759/cureus.8420

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Abstract

Metastases to the colon are rare and may mimic other diseases such as inflammatory bowel disease. This differential diagnosis is often overlooked by endoscopists which leads to unnecessary diagnostic delay or inappropriate treatment. We present a case of a 54-year-old woman who presented with ascites. Malignant cells were demonstrated on cytologic examination of ascitic fluid, but no primary tumour or metastases were seen on computed tomography of the abdomen. On colonoscopy, an impassable stenosis was found in the transverse colon with scattered patches of oedematous colonic mucosa through to the mid-descending colon. Histological examination revealed scattered signet ring cells and the diagnosis of gastric signet ring cell adenocarcinoma was confirmed with subsequent gastroscopy. The correct and timely diagnosis of metastatic lesions to the colon requires a high index of suspicion and adequate mucosal sampling with multiple biopsies.

Highlights

Secondary malignant tumours of the colon are rare and are estimated to account for 1%-3% of colonic tumours [1,2]
Metastases to the colon are rare and may mimic other diseases such as inflammatory bowel disease. This differential diagnosis is often overlooked by endoscopists which leads to unnecessary diagnostic delay or inappropriate treatment
The correct and timely diagnosis of metastatic lesions to the colon requires a high index of suspicion and adequate mucosal sampling with multiple biopsies

Summary

Introduction

Secondary malignant tumours of the colon are rare and are estimated to account for 1%-3% of colonic tumours [1,2]. Signet ring cell adenocarcinoma is an aggressive malignancy characterized by mucin-producing cells, which most commonly arises from the stomach, but has been reported from the breast, colon, and prostate [4]. We present a case of a patient with colonic metastases of gastric signet ring cell adenocarcinoma. In the month prior to evaluation, she noted increasing abdominal distension and anorexia resulting in a 3 kg weight loss Her bowel habitat was regular and remained unchanged from her baseline She had no family history of gastrointestinal malignancy or liver disease and no known exposure to tuberculosis. How to cite this article Hanzel J, Ranković B, Ribnikar M (June 03, 2020) Metastatic Gastric Signet Ring Cell Adenocarcinoma Presenting With Colonic Stenosis. The histopathology was consistent with metastatic signet ring cell carcinoma and subsequent gastroscopy confirmed the primary tumour. She was started on palliative chemotherapy and died nine months after diagnosis - without developing symptoms of colonic obstruction

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