Case report: A case of delayed cutaneous metastases from signet-ring cell mixed-type gastric cancer

Abstract

BackgroundSignet-ring cell gastric carcinoma is a highly malignant tumor, with the characteristics of strong invasiveness, rapid progression, a high degree of malignancy, and generally poor prognosis. The most common site of metastases is the abdominal organs, especially the liver, while delayed cutaneous metastases are rare.Case presentationWe report a case of cutaneous metastases on the head, groin, and thigh, which recurred 7 years after signet-ring cell gastric carcinoma surgery. The patient was diagnosed with a 2.0×1.5×1.0cm tumor at the angle of stomach, and treated with Billroth II distal gastrectomy accompanied with D2 lymph node dissection. According the pathology, the stage was pT1N3M0. Then the patient received two cycles of oxaliplatin and tegafur chemotherapy, which was discontinued due to the inability to tolerate the side effects of chemotherapy. Seven years after the surgery, the patient initially presented with a fleshy mass on the head and beaded nodules in the groin; then, the mass gradually became larger, along with the thighs turning red, swollen, and crusty. Firstly, the patient was diagnosed with “lower extremity lymphangitis” and treated mostly with anti-inflammatory, promote lymphatic return, detumescence and elastic force cannula in vascular surgery department. However, the symptoms relieved insufficient. Finally, the skin biopsy indicates a signet-ring cell gastric carcinoma cutaneous metastasis. The whole-body PET-CT examination showed multiple nodules with increased metabolism. Then the patient was transferred to The Department of Oncology for further chemotherapy.ConclusionOur case highlights that gastric tumor recurrence and metastasis should be highly suspected when skin lesions appear in patients with signet-ring cell gastric carcinoma. At the same time, multidisciplinary consultation and close cooperation between surgeons, oncologists, and dermatologists are of great significance to the diagnosis and treatment of this disease.

Inflammatory cutaneous metastases originating from gastric cancer: A case report

“…We found 13 cases in the PubMed database between 2014 and 2023 (Table 1 ). The most common site of cutaneous metastasis in GC is around the umbilicus and mainly occurs in males[ 2 , 3 , 5 , 13 , 17 ], and signet-ring cell carcinoma has a greater tendency[ 2 - 5 , 17 ].…”

“…Cutaneous metastases of GC mainly manifest as nodules or masses[ 1 , 5 , 10 , 11 ]. Less frequently, they appear like sclerodermoid or inflammatory lesions[ 2 , 3 , 4 , 9 ]. In most cases, the latter two manifestations gradually develop from nodules[ 2 , 4 ].…”

“…Less frequently, they appear like sclerodermoid or inflammatory lesions[ 2 , 3 , 4 , 9 ]. In most cases, the latter two manifestations gradually develop from nodules[ 2 , 4 ]. In this case, we first observed the inflammatory lesions, followed by sclerodermoid lesions and nodules.…”

“…Gastric cancer (GC) is a highly heterogeneous disease, and the typical sites of metastasis are the liver, lung, bone, and the peritoneum[ 1 ]. Cutaneous metastasis of GC is extremely rare, occurring in 0.2% to 1% of cases[ 2 - 4 ]. Cutaneous metastasis usually occurs in the late stage but sometimes appears as the first manifestation[ 5 - 9 ].…”

“…Cutaneous metastasis usually occurs in the late stage but sometimes appears as the first manifestation[ 5 - 9 ]. Single or multiple nodules are the most common clinical presentations[ 1 , 2 , 5 - 7 , 10 - 12 ]. In this paper, we report a patient with GC who developed cutaneous metastases with extensive redness and swelling, followed by skin thickening and nodules.…”