Characteristics of intramural metastasis in gastric cancer

Abstract

Background Intramural metastasis (IM) in gastric cancer is rare. However, it often occurs with esophageal squamous cell carcinoma and has been reported to have a poor prognosis. Methods In 4,714 cases of gastric cancer that underwent gastrectomy, the clinicopathological features and postoperative prognoses of 29 cases with IM were evaluated and compared with 2,770 cases of advanced gastric cancer without IM. Results Of the 4,714 cases, 29 (0.6 %) were histopathologically diagnosed with gastric cancer with IM. There were significant differences in the number of lymph node metastases, capillary invasion, and stage grouping between cases with IM and advanced gastric cancer without IM. Metastasis size was approximately within 2 cm, and many metastases occurred within 2 cm of the primary lesion. Multiple metastases were observed in 38 % of cases and occurred mainly in the submucosa and muscularis propria. IM was detected preoperatively in 17.2 % of cases and was present equally on both sides of the primary lesion. Nine cases had IM outside the stomach. The median survival time with IM was significantly less than in cases of advanced gastric cancer without IM (p \ 0.0001). A subgroup of cases with IM within 1 cm of the primary lesion had a relatively favorable prognosis. Conclusions The presence of IM is thought to be one of the most important prognostic factors in gastric cancer. Aggressive resection is recommended to increase longterm survival if curative resection is possible.

Intramural metastasis to the appendix from ascending colon cancer: a case report

“…Intramural metastasis is defined as a metastatic tumor spreading from the primary tumor to the digestive tract through the intramural lymphatic system [1]. Intramural metastasis is rare in colorectal cancer, although this type of metastasis has been frequently reported in esophageal and gastric cancer [1,2]. To the best of our knowledge, there is only one report of suspected intramural metastasis from colon cancer to the appendix [4].…”

“…However, there is a possibility of intramural metastasis from transverse colon cancer to the appendix; therefore, awareness of our rare case of intramural metastasis is important. Intramural metastasis is considered an important factor predicting poor prognosis in esophageal [3,8,9], gastric [2], and rectal [5] cancers. Although there is a lack of consensus regarding treatment strategies, intramural metastasis might also be a poor prognostic factor in metastasis from colon cancer to the appendix.…”

“…Intramural metastasis is rare in colorectal cancer, although this type of metastasis has been frequently reported in esophageal and gastric cancer [1,2]. The presence of intramural metastasis is an important poor prognostic indicator [3].…”

Clinical presentation and treatment of gastric metastasis from other malignancies of solid organs

“…The microlymphatic system in the esophageal submucosa is thought to be continuous with that in the gastric submucosa, and this may be associated with the mechanism underlying gastric metastasis (6,14). In the present study, in all three patients with gastric metastases from esophageal cancer, the metastatic tumors were located in the upper gastric body close to the esophagocardial junction, which could be explained by metastases occurring via the lymphatic system.…”

“…Although the mechanisms underlying gastric metastasis have not been clearly elucidated, potential pathways may include peritoneal dissemination, hematogenous dissemination, lymphatic spread, and direct tumor invasion (1). In the case of hematogenous dissemination, tumor cells may become trapped in vessels in areas of the stomach wall with a rich blood supply, such as the submucosal or subserosal layers (6). Investigations into the mechanisms responsible for gastric metastasis depending on the primary malignancy are expected in the near future.…”