Sigmoid colonic metastasis by lymphatic spread occurring with unilateral Krukenberg tumor considered to be caused by stage IA early gastric cancer: A case report

Fujimoto,Daisuke; Hirono,Yasuo; Goi,Takanaori; Yamaguchi,Akio

doi:10.3892/ol.2015.3919

Sigmoid colonic metastasis by lymphatic spread occurring with unilateral Krukenberg tumor considered to be caused by stage IA early gastric cancer: A case report

Authors:
- Daisuke Fujimoto
- Yasuo Hirono
- Takanaori Goi
- Akio Yamaguchi
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Affiliations: First Department of Surgery, Faculty of Medicine, University of Fukui, Fukui 910‑1193, Japan
Published online on: November 16, 2015 https://doi.org/10.3892/ol.2015.3919
Pages: 668-672

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Abstract

Gastric cancer is one of the most common malignancies in Asia, and the second most common cause of cancer-associated mortality in Japan. Colorectal metastases originating from gastric adenocarcinoma are extremely rare. The present study reports an unusual case of lymphogenous sigmoid metastasis of gastric adenocarcinoma occurring in a 58‑year‑old female patient. Endoscopic and radiological findings were indicative of 0‑IIc+IIa early gastric cancer, and radical distal gastrectomy with D2 lymph node dissection was performed. The pathological diagnosis was stage IA gastric adenocarcinoma (T1bN0M0), according to the Japanese classification of gastric cancer. A follow‑up examination at 18 months post surgery revealed a recurrence of paraaortic lymph node metastasis, detected by abdominal computed tomography (CT) and positron emission tomography (PET)/CT. The patient received chemotherapy with S‑1 and cisplatin. Subsequently, radiotherapy was administered to the paraaortic lymph nodes at levels Th11‑L3. Follow‑up abdominal CT and PET/CT revealed an enlarged left ovary, and abnormal uptake in the left ovary and sigmoid colon. An oophorectomy and sigmoidectomy with D3 lymph node dissection were performed. The pathological diagnosis was metastatic adenocarcinoma; this was identical to the gastric pathology in the previous pathological report. The patient continued treatment with chemotherapy. Although sigmoid colonic metastasis from gastric cancer is extremely rare, metastasis from gastric cancer must be considered during the differential diagnosis of cases involving a colorectal mass and a previous history of gastric cancer.

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1	Hamashima C, Ogoshi K, Okamoto M, Shabana M, Kishimoto T and Fukao A: A community-based, case-control study evaluating mortality reduction from gastric cancer b∂y endoscopic screening in Japan. PLoS One. 8:e790882013. View Article : Google Scholar : PubMed/NCBI
2	Baston OV: The function of the vertebral veins and their role in the spread of metastases. Ann Surg. 112:138–149. 1940. View Article : Google Scholar : PubMed/NCBI
3	Rodriguez Salas N, González PC, Rivera T, López AA, Martín Marino A and Lara Alvarez MA: Colonic anastomosis and colonic polyp mucosal metastasis of signet ring cell gastric adenocarcinoma. Clin Transl Oncol. 12:238–239. 2010. View Article : Google Scholar : PubMed/NCBI
4	Ogiwara H, Konno H, Kitayama Y, Kino I and Baba S: Metastases from gastric adenocarcinoma presenting as multiple colonic polyps: Report of case. Surg Today. 24:473–475. 1994. View Article : Google Scholar : PubMed/NCBI
5	Katon RM, Brendler SJ and Ireland K: Gastric linitis plastica with metastases to the colon: A mimic of Crohn's disease. J Clin Gastroenterol. 11:555–560. 1989. View Article : Google Scholar : PubMed/NCBI
6	Metayer P, Antonietti M, Oumrani M, Hemet J, Lemoine F and Basuyau J: Metastases of gastric adenocarcinoma presenting as colonic polyposis. Report of a case. Dis Colon Rectum. 34:622–623. 1991. View Article : Google Scholar : PubMed/NCBI
7	Iwabuchi M, Hiwatashi N, Suzuki T, Teshima S, Saito T, Suzuki H, Mori Y, Ishibashi J, Chida N and Tadokoro K: Multiple depressed-type colonic cancer (IIc)-like configurations: metastases from gastric cancer. Dig Endosc. 14:73–77. 2002. View Article : Google Scholar
8	Japanese Gastric Cancer Association: Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 14:101–112. 2011. View Article : Google Scholar : PubMed/NCBI
9	Feczko PJ, Collins DD and Mezwa DG: Metastatic disease involving the gastrointestinal tract. Radiol Clin North Am. 31:1359–1373. 1993.PubMed/NCBI
10	D'Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M and Karpeh MS: Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg. 240:808–816. 2004. View Article : Google Scholar : PubMed/NCBI
11	Yoo CH, Noh SH, Shin DW, Choi SH and Min JS: Recurrence following curative resection for gastric carcinoma. Br J Surg. 87:236–242. 2000. View Article : Google Scholar : PubMed/NCBI
12	Berek JS and Natarajan S: Ovarian and fallopian tube cacner. J Korean Gastric Cancer Assoc. 1:106–112. 2001.
13	Lee HC, Yang MT, Lin KY, Tu HY, Zhang TA and Chen PH: Metastases from gastric carcinoma to colon in the form of multiple flat-elevated lesions: A case report. Kaohsiung J Med Sci. 20:552–557. 2004. View Article : Google Scholar : PubMed/NCBI
14	Hiraga Y, Yasui W, Kumamomto T, Watanabe M, Kobayakawa M, Eguchi N, Nakamura T, Kawamura H, Nakai S and Kamei F: Colonic metastases of signet-ring cell carcinoma presenting as multiple small depressed lesions like erosions: Report of a case. Nippon Shokakibyo Gakkai Zasshi. 99:615–621. 2002.(In Japanese). PubMed/NCBI
15	Metayer P, Antonietti M, Oumrani M, Hemet J, Lemoine F and Basuyau J: Metastases of a gastric adenocarcinoma presenting as colonic polyposis. Report of a case. Dis Colon Rectum. 34:622–623. 1991. View Article : Google Scholar : PubMed/NCBI
16	Gao B, Xue X, Tai W, Zhang J, Chang H, Ma X, Qi Y, Cui L, Yan F and Pan L: Polypoid colonic metastases from gastric stump carcinoma: A case report. Oncol Lett. 8:1119–1122. 2014.PubMed/NCBI
17	Kummar S, Fogarasi M, Canova A, Mota A and Ciesielski T: Cytokeratin 7 and 20 staining for the diagnosis of lung and colorectal adenocarcinoma. Br J Cancer. 86:1884–1887. 2002. View Article : Google Scholar : PubMed/NCBI
18	Jaeger T, Ring J and Andres C: Histological, immunohistological, and clinical features of merkel cell carcinoma in correlation to merkel cell polyomavirus status. J Skin Cancer. 2012:9834212012. View Article : Google Scholar : PubMed/NCBI
19	Chu P, Wu E and Weiss LM: Cytokeratin 7 and cytokeratin 20 Expression in Epithelial Neoplasms: A Survey of 435 cases. Pathol. 13:962–972. 2000.
20	Park SY, Kim HS, Hong EK and Kim WH: Expression of cytokeratins 7 and 20 in primary carcinomas of the stomach and colorectum and their value in the differential diagnosis of metastatic carcinomas to the ovary. Hum Pathol. 33:1078–1085. 2002. View Article : Google Scholar : PubMed/NCBI