A Large Cutaneous Metastases Derived From Gastric Adenocarcinoma: Case Report Study

AUTHORS

Ahmad R Mafi ORCID 1 , *

1 Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

How to Cite: Mafi A R. A Large Cutaneous Metastases Derived From Gastric Adenocarcinoma: Case Report Study, Rep Radiother Oncol. Online ahead of Print ; 7(1):e102273. doi: 10.5812/rro.102273.

ARTICLE INFORMATION

Reports of Radiotherapy and Oncology: 7 (1); e102273
Published Online: June 1, 2020
Article Type: Case Report
Received: March 1, 2020
Revised: April 8, 2020
Accepted: April 20, 2020
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Abstract

To our knowledge, cutaneous metastases originated from gastric cancer are quite rare, observed for only 6% of all skin metastases in males as well as 1% in females. The cutaneous metastases show the severity of the progressed disease with poor prognosis. This case report presents a rare metastatic form observed from a 27-year-old male patient with gastric cancer who complained from a large skin lesion along with few visceral metastases. Following four cycles of palliative chemotherapy, he discontinued the treatment and began to consume some herbal medicines. As he had a few stable visceral metastases previously without any progression, we presumed that he passed away due to septic complications of the skin lesions rather than visceral crisis.

Copyright © 2020, Reports of Radiotherapy and Oncology. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Introduction

Cutaneous metastasis originated from internal malignancies is relatively uncommon. It is estimated that in 0.7% - 10.4% of patients, skin metastasis at the same time with different malignancies might be developed (1). Cutaneous lesions from gastric carcinoma are quietly a rare finding which have been reported in 6% of all skin metastases in males as well as 1% in females derived from gastric cancer (2). It usually affects the areas which are near to the primary tumor (abdominal wall) and often manifests as non-specific nodules (3). Here, we reported a rare case of cutaneous metastases from gastric adenocarcinoma, clinically presented by multiple large erythematous skin nodules and tumors affecting the scalp, chest wall as well as both anterior and posterior triangle of the neck.

2. Case Presentation

A 27-year-old man referred to our clinic with the diagnosis of gastric adenocarcinoma. Further checkup determined that there are two metastatic lesions in the liver tissue confirmed by biopsy. The patient was illiterate and came from a remote village in the center of Iran. Although, it was difficult to take an accurate family history, it seemed that he was the first member of the family with such a problem. No genetic counselling was provided due to refusing to travel to Tehran. After the fourth cycle of palliative chemotherapy, he decided to discontinue treatment and returned after 11 months. At that time, he seemed weaker and had weight-lost more than 20 kg, and was complaining of skin lesions that had grown over the last 4 months on his chest, neck, and head. Following the physical examination, large erythematous skin nodules and tumors could be seen on both anterior and posterior sides of his chest and neck as well as a large tumor on his scalp (Figures 1-3). He mentioned that the skin problems had begun as small erythematous lesions on his chest and subsequently had progressed over a few months. After that, several biopsies were prepared, and the pathology report confirmed the diagnosis of metastatic signet ring cell (adeno) carcinoma of gastric origin. Surprisingly, computed tomography (CT) of chest, abdomen, and pelvis showed a stable disease, with no visceral metastatic progression. Therefore, palliative chemotherapy was recommended. Nevertheless, he refused the treatment and preferred to continue using the herbal medicines that he had been using since the lesions had more developed. Unfortunately, he did not come back for a checkup and continuing related treatment. Finally, following a phone call from his father, we were informed that he passed away a couple of months after his last visit.

Huge tumor in posterior neck and chest
Figure 2. Huge tumor in posterior neck and chest
Huge tumor in anterior neck and chest
Figure 3. Huge tumor in anterior neck and chest

3. Discussion

Skin is an uncommon site for distant metastasis, which could usually be a sign of an advanced stage of a disease with a poor prognosis (4). Among different malignancies, different cancers, including breast, lung, oral mucosa, and colorectal cancer, are most likely to metastasize to the skin (3). A well-known example of skin involvement from gastrointestinal cancers is Sister Mary Joseph’s nodule (SMJN), which usually manifests as a cutaneous nodule on the umbilicus. SMJN accounts for about 60% of all malignant umbilical tumors (5). In addition, metastatic involvement of the skin usually develops by direct invasion of the nearby tumor such as skin involvement in breast cancer, which often occurs in the overlying skin of the involved breast (1). Skin metastasis can also observe through the lymphatic or hematogenous spread. According to the literatures, most of the cases of skin metastases with gastric cancer origin have been observed in the skin tissue of the abdominal wall (1, 3). Skin lesions, in our case, had unusual sites of involvement as well as the extraordinary large size. Interestingly, although in the majority of the cases, skin involvement is usually a sign of advanced disease, our patient did not have advanced visceral disease, and two hepatic lesions remained stable despite a significant progression of the skin disease. We were informed by his father that he passed away a couple of months after the last visit with progressive ulceration and infection of skin lesions. Despite he had only two metastatic hepatic lesions that had been stable for about a year, we assumed that the main reason of death probably was due to the septic complications of the skin lesions rather than visceral crisis. The gastric cancer was developed in this patient at a very young age, besides the unusual presentations. Probably, he and his family needed a comprehensive history taking and genetic counseling. However, cultural barriers, negligence, poor knowledge, and wrong beliefs about the efficacy and indications of herbal medicines, resulted in a suboptimal care and management for his disease.

Footnotes

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