Metastatic Tumors to the Stomach: Analysis of 83 Patients Diagnosed by Endoscopy

Abstract

Background: Metastases to the gastrointestinal tract are considered unusual site for malignant tumors. There have been a few published reports on metastatic lesions to the stomach about endoscopic findings. We investigated endoscopic features of metastatic tumors to the stomach from distant sites. Patients and Method: We used retrospectively entered database (from 1968 to 2002) to identify all patients with metastatic tumors to the stomach, which were detected endoscopically at the National Cancer Center Hospital in Tokyo. Patients with leukemia, malignant lymphoma with gastric involvement, or gastric invasion directly from neighboring organs, were excluded from this study. Results: The primary sites were as followings; lung (18cases, 22%), malignant melanoma (17cases, 20%), breast (16cases, 19%), esophagus (16cases, 19%), and the others (head and neck; 4, ovary; 3, uterus; 2, testis; 2, biliary tract; 1, kidney; 1, and unknown; 3). Among 83 cases with metastatic tumors to the stomach, 49 cases (59%) had solitary gastric lesion and the rest 34 cases had multiple lesions (41%). Seventy-six cases (92%) of the metastatic tumors were located in the middle or upper third of the stomach. In the endoscopic appearance, 41 patients had lesions resembling submucosal tumor. Twenty-eight patients, including 4 patients with Borrman 4 like formation, had tumors resembling primary gastric cancer. Three of four cases looked like Borrman 4 gastric cancer were from breast cancer. In all cases with malignant melanoma, small black dots were recognized. Conclusions: When we faced the features mentioned above at endoscopic examination, metastatic tumor to the stomach should be considered as a differential diagnosis.