Advanced stomach cancer remains a serious disease with a poor prognosis. Skeletal muscle metastases of gastric carcinoma are extremely rare and may be revealing the disease. The signet ring cell carcinoma is defined by the presence of proportion of independent cells greater than 50%. In an advanced stage it has a more aggressive character with a greater risk of lymph node invasion or distant metastasis. The needle biopsy is required for diagnosis. The chemoresistance of SRCC appear as elements of poor prognosis. The armamentarium includes further the antitumor chemotherapy, radiotherapy and palliative care adapted to the patient's clinical context.

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The introduction of immune checkpoint inhibitors (ICIs) has significantly improved cancer management and survival outcomes .One third of patients exposed to ICI will develop gastrointestinal adverse events (GIAEs). Knowledge of these toxicities, along with effective management algorithms, is essential to enable early diagnosis and treatment, decreasing morbidity and mortality.