Diagnosis Of Gastric Metastasis Research Articles

Application of 18F Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Monitoring Gastric Metastasis and Cancer Thrombi from Renal Cell Carcinoma.

Background Renal cell carcinoma (RCC) with gastric metastasis is rare, particularly accompanied by multiple cancer thrombi. Methods We reported a 66-year-old man with a history of a right radical nephrectomy because of RCC. The patient underwent 18F prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) scanning after 6 months of targeted therapy because of gastric metastasis and cancer thrombi. We conducted a systematic review of the literature and identified 73 cases of RCC with gastric metastasis. We analyzed the clinicopathological characteristics, therapies, and outcomes of patients. Results 18F-PSMA PET/CT showed a large mass in the gastric fundus and cancer thrombi in the right atrium, inferior vena cava, and splenic vein with intense tracer uptake. Other metastases with increased tracer uptake included multiple bones and abdominal lymph nodes. The majority of gastric metastasis of RCC were men (53/73, 72.6%), with a median age at presentation of 67 (from 48 to 87) years. Gastric metastasis of RCC was mainly metachronous, and presented with small polyps or mass appearance and often accompanied by multiple-site metastases and gastrointestinal symptoms. An overall median interval between nephrectomy and diagnosis of gastric metastasis was 6 (from 0.1 to 23) years, and an overall median survival time was 14 (from 0.25 to 72) months. The median interval time of solitary gastric metastasis was longer than gastric metastasis with multiple-site metastases (7 vs.5 years; P=0.034). Patients with gastric and multiple-site metastases had higher mortality than patients with solitary metastasis (17 vs.1; P=0.028). The patients with synchronous gastric metastasis had a shorter survival time than metachronous gastric metastasis (6 vs.17 months; P=0.018). Conclusions Postoperative follow-up of multiple imaging modalities to monitor recurrence and metastasis is necessary and important. PSMA PET/CT can improve the detection sensitivity of RCC, especially in metastatic clear cell renal cell carcinoma (ccRCC), and could provide a basis for disease staging, restaging, and therapeutic efficacy evaluation.

2703 Gastric Metastasis From a Primary Ovarian Cancer

INTRODUCTION: Metastasis to stomach is very rare in general and often related to a breast or a lung primary. Ovarian cancer metastasizing to the stomach is extremely rare. We are reporting a very unusual case of a lady who had gastric metastasis from the primary ovarian cancer more than 3 years after the initial diagnosis. Serosal tumors are more likely to metastasize in comparison to the mucinous type. CASE DESCRIPTION/METHODS: A 49 year old Hispanic lady who had originally presented 3.5 years prior to her recent admission with abdominal pain and bloating. Work-up confirmed bilateral ovarian masses. Staging was negative for liver, lung and brain involvement. She had surgery. The pathology confirmed papillary serous adenocarcinoma with appendiceal and omental involvement. Estrogen and progesterone receptors were positive. She was considered to have Stage III-C disease, and started with chemotherapy. Unfortunately, within a few months, she came in with shortness of breath with imaging showing bilateral pleural effusions. She had thoracentesis which confirmed metastasis from her primary ovarian cancer. Her staging status was changed to IV. She was started on palliative chemotherapy. She would respond partially at first, but then she did show progression of the cancer. She then presented to the hospital recently with GI bleeding, anemia, sepsis, acute renal failure, leukocytosis and respiratory compromise. An upper endoscopy showed a large cratered malignant appearing ulcer in the body of the stomach. Biopsies confirmed adenocarcinoma from the ovarian source. Based on her advanced disease, and multi-system organ failure, the family decided on hospice care. DISCUSSION: Ovarian cancer metastasizing to the stomach is exceedingly rare. The symptoms are usually vague as the involvement is often serosal or sub-mucosal from local infiltration from the peritoneal carcinomatosis. However, hematogenous spread can occur as well. Presentation is often late, months to years after the initial diagnosis of the cancer. EGD should be considered in ovarian cancer patients presenting with upper GI symptoms. EUS/FNA biopsy may help in the diagnosis of the submucosal lesions. Prognosis is usually poor with average life expectancy after the diagnosis of gastric metastasis being 15 months.

An Unexpected Cause of Dyspepsia and Ascites

A 59 year old woman with a history of ductal breast carcinoma in remission, type two diabetes, and hypertension, presented to an academic medical center from an outside community hospital with ascites presumed to be from new onset liver disease. For two to three months, she had been having diffuse abdominal pain, early satiety, and abdominal distension. She had also been having bloating, nausea, and regurgitation. Laboratory studies showed mildly elevated transaminases and INR elevation to 1.7. At the outside hospital, extensive workup, including right upper quadrant ultrasound, CT abdomen and pelvis, and barium follow through study, showed delayed gastric emptying, hepatic steatosis, and ascites with no evidence of any masses or lymphadenopathy. EGD showed abnormal appearing gastric mucosa, but biopsies were negative. After transfer, paracentesis revealed a serum ascites albumin gradient of 1.1, a total protein of 3.4g, WBC count 6000, and highly atypical cells on cytology. Findings from MRI abdomen were only notable for a thickened gastric wall. Endoscopic ultrasound showed a total loss of wall layer definition extending to the muscularis propria and increased wall thickness of 8mm. Biopsies of the antrum and duodenum were collected and showed highly invasive adenocarcinoma consistent with triple negative breast cancer. This case raises the importance of considering gastric metastasis in patients with a history of cancer and vague abdominal symptoms. Gastric metastases are rare, occurring in 0.5% of cancer patients. However, breast cancer accounts for 25% of these cases. Similar to this patient, diagnosis occurs on average 50-78 months after completion of therapy. Complicating diagnosis, mucosal biopsy can be negative up to 20% of the time. Breast cancer metastasis to the stomach is typically seen with lobular cancer, unlike in this case. Chemotherapy geared towards the primary cancer is the most common treatment modality, with surgical intervention pursued infrequently. Symptomatic management with diuretics is controversial and therapeutic paracentesis is more commonly practiced. Nutritional support is key, particularly if the tumor impairs gastric emptying as in the case of our patient. Prognosis after diagnosis of gastric metastasis is about 2 years.

Clinicopathological Features of Metastatic Gastric Tumors Originating From Breast Cancer: Analysis of Eleven Cases.

BackgroundMetastatic gastric tumor originating from breast cancer (MGTBC) is rare. Endoscopically, gastric cancer (GC)-like lesions and submucosal tumors (SMT) are the features of MGTBC. Their clinicopathological characteristics are currently uncertain. We analyzed the clinicopathological characteristics of 11 patients with MGTBC to better understand the disease progression and thereby improve early detection methods.MethodsFrom 2006 to 2016, 11 patients with MGTBC diagnosed by esophagogastroduodenoscopy (EGD) were included.ResultsAll 11 patients were women, with a median age of 57 years. Histological examination revealed six cases with solid tubular components and five cases with invasive lobular carcinoma components. Melena was the most common symptom; however, asymptomatic cases were also common. Seven and four cases had GC-like lesions and SMTs, respectively. Six of the seven cases had GC-like lesions with peritoneal metastasis, whereas none of the four SMT cases had peritoneal metastasis (P = 0.015). The median overall survival (OS) in all cases was 26 months (range, 1 - 42 months). OS in cases treated with chemotherapy after a diagnosis of gastric metastases was significantly better than that in those treated without chemotherapy (P = 0.047). One patient showed gradual transformation from an SMT-type lesion to a Borrmann type 4-like appearance.ConclusionsMGTBC is a rare occurrence; however, it should be considered when gastric tumors, especially GC-like lesions in patients with a medical history of breast cancer are found. Patients with breast cancer, especially invasive lobular carcinoma, should undergo screening EGD regularly to detect gastric metastases early and receive chemotherapy to obtain good outcomes.

Clinical and Endoscopic Features of Metastatic Tumors in the Stomach.

Background/AimsMetastasis to the stomach is rare. The aim of this study was to describe and analyze the clinical outcomes of cancers that metastasized to the stomach.MethodsWe reviewed the clinicopathological aspects of patients with gastric metastases from solid organ tumors. Thirty-seven cases were identified, and we evaluated the histology, initial presentation, imaging findings, lesion locations, treatment courses, and overall patient survival.ResultsEndoscopic findings indicated that solitary lesions presented more frequently than multiple lesions and submucosal tumor-like tumors were the most common appearance. Malignant melanoma was the tumor that most frequently metastasized to the stomach. Twelve patients received treatments after the diagnosis of gastric metastasis. The median survival period from the diagnosis of gastric metastasis was 3.0 months (interquartile range, 1.0 to 11.0 months). Patients with solitary lesions and patients who received any treatments survived longer after the diagnosis of metastatic cancer than patients with multiple lesions and patients who did not any receive any treatments.ConclusionsProper treatment with careful consideration of the primary tumor characteristics can increase the survival period in patients with tumors that metastasize to the stomach, especially in cases with solitary metastatic lesions in endoscopic findings.

Clinicopathological features of gastric metastasis from breast cancer in three cases

The common sites for metastases from breast cancer are lymph nodes, bone, lung, liver, and brain. Gastrointestinal (GI) metastasis is rarely found or diagnosed in patients with breast cancer. This report presents three cases of gastric metastasis from breast cancer. Case1 was a 42-year-old female diagnosed with gastric metastasis after mastectomy with axillary lymph node dissection for invasive lobular carcinoma of the left breast. Case2 was a 54-year-old female who was diagnosed to have invasive lobular carcinoma of the left breast with systemic bone and gastric metastasis. Case3 was a 54-year-old female who was diagnosed to have bilateral invasive ductal carcinoma of the breast with simultaneous bone and gastric metastasis. The immunohistochemical statuses for estrogen receptor, progesterone receptor, mammaglobin, and gross cystic disease fluid protein-15 (GCDFP-15) between the primary and gastric metastatic lesions were all well matched. All three cases were treated with systemic chemotherapy, hormone therapy or both, without surgical intervention for gastric lesions. Two patients with disseminated disease died 27 and 58months after diagnosis of gastric metastasis, while one patient without organ metastasis is still alive at 56months after diagnosis. It is important to make a correct diagnosis by distinguishing gastric metastasis from breast cancer in order to select the optimal initial treatment for systemic disease of breast cancer.

Gastric metastases. An endoscopic series of ten cases

We report a series of ten cases of the clinical, endoscopic and pathological features of gastric metastases. Patients were six women and four men between 54 and 88 years old, with gastric metastases from breast carcinoma (4), lung carcinoma (4) and melanoma (2). Patients underwent an upper gastrointestinal endoscopy for epigastralgia (2), hematemesis (2), dysphagia (1) and anemia (5). On endoscopy, tumors appeared as nodules with a central ulceration (5), an ulceration (4) or simulating linitis plastica (1). Metastases were located in the cardia (2), fundus (5) and antrum (3). Primary tumors had been diagnosed between one day and 20 years before upper endoscopy. Eight patients had multivisceral metastases. The microscopic features of the gastric metastases resembled a primary gastric cancer in eight cases. Thanks to clinical data, the pathologist confirmed the diagnosis of gastric metastases on immunohistochemistry. Nine patients died in the eight-month follow-up period. Gastric metastases are rare, occur at a late stage of the neoplastic disease, and have a poor prognosis. Diagnosis of gastric metastases is difficult because they simulate primary gastric cancer on endoscopy and on microscopic examination. A correct diagnosis is based on good communication between gastroenterologists and pathologists.

Gastric metastasis by primary lung adenocarcinoma

The diagnosis of gastric metastasis from lung cancer is relatively rare in living patients. We describe a case of Type 4 tumor-like metastasis due to primary lung cancer diagnosed with immunohistochemical staining while the patient was alive. A 68-year-old man was admitted to our hospital because of epigastric pain. Gastrointestinal endoscopy revealed a Type 4 tumor and the histological examination showed poorly differentiated adenocarcinoma. His chest X-ray showed mass shadow in the right upper lung field. The resected specimens showed moderately differentiated adenocarcinoma., The diagnosis of gastric metastasis from lung cancer was made by immunohistochemical staining of the lung and gastric tumors which showed positive staining for Thyroid transcriptional factor-1. Diagnosis of gastric metastasis, especially Type 4 metastasis by lung cancer is difficult. However, immunohistochemical staining is very helpful for diagnosis of primary lung cancer metastasis at sites such as the gastrointestinal tract which are not normally prone to metastatis.

Metastatic cancer to the stomach

Metastases in the stomach are rare. The increased use of esophagogastroduodenoscopy (EGD), associated with better treatment results for malignancies, requires them to be acknowledged. The aim of this study was to describe a series of cases of metastasis to the stomach, their primary sites, clinical and endoscopic features, treatment, and results. Twenty cases were diagnosed between December 1999 and January 2004. Their analysis included symptomatology, macroscopic presentation, time from diagnosis of the primary tumor to the detection of the gastric metastasis, treatment approach, and survival. The primary sites were the esophagus, skin, lung, cervix, breast, sigmoid colon, and testis. The symptom most frequently requiring EGD was upper gastrointestinal bleeding. Ten patients showed concomitant metastases to other organs. The mean time between diagnosis of the primary tumor and diagnosis of gastric metastasis was 16 months (range, 0 to 56 months). Only seven patients were given some form of treatment after diagnosis of the gastric metastasis. The median survival was 4.75 months. Overall survival during the first year was 20% and survival was nil at 2 years. Gastric metastasis marks advanced disease and the prognosis is poor. New advances in diagnosis and treatment are required for better results.

A CASE OF SYNCHRONOUS GASTRIC METASTASIS FROM RENAL CARCINOMA WITH THE CHIEF COMPLAINT OF HEMATEMESIS

Metastatic tumors to the stomach are quite uncommon. Rarer still is renal carcinoma metastatic to the stomach, which are usually reported in several autopsy series. Recently, a case of renal carcinoma with solitary gastric metastasis during life was experienced. A 61-year-old woman was admitted to the hospital because of hematemesis. Gastric endoscopy showed multiple polypoid lesions in the upper body of the stomach. Endoscopic biopsy revealed the most possible metastatic lesion from renal carcinoma. Microscopic findings, ultrasonography computed tomography and angiogram led to the diagnosis of gastric metastasis from left renal carcinoma. Left radical nephrectomy, total gastrectomy, distal pancreatectomy and splenectomy were carried out simultaneously. Almost cases of gastric metastasis of renal carcinoma have been heterochronously confirmed following nephrectomy. In a review of the literature, this case, in which primary and metastatic lesions were diagnosed preoperatively and resected at the same time, appears to be the first case reported in Japan and abroad.