Late Cutaneous Metastasis Originating from Gastric Cancer with Synchronous Metastasis

Abstract

An 89-year-old man was diagnosed with late cutaneous metastasis in the right axilla 6 years after undergoing a surgery for gastric cancer with synchronous cutaneous metastasis in the same site. The patient became aware of small reddish nodules in the right axilla, and computed tomography imaging showed an irregular thickening of the right axillary skin. No other sign of recurrence was observed. By en-bloc resection, the nodules were diagnosed as late cutaneous metastasis from gastric cancer. The patient received no additional postoperative chemo- or radiotherapy and was only carefully observed. Cutaneous metastases from gastric cancer have a high recurrence rate even if total resection with no residual cancer is achieved. Therefore, meticulous follow-up, including routine visual inspection, is required for the early detection of late cutaneous metastases.

Metachronous port site, muscular and subcutaneous metastases from a gastric adenocarcinoma: a case report and review of articles

“…We searched the PubMed database for earlier case reports treated by surgical excision of subcutaneous metastasis due to gastric cancer using the key words "gastric cancer, " "cutaneous metastasis, " "subcutaneous metastasis, " and "skin metastasis. " We found six subcutaneous metastasis cases without any other synchronous metastases after curative gastrectomy (Table 3) [22][23][24][25][26][27]. The median age was 68 years (range 60-89 years).…”

Livedoid cutaneous metastasis of signet‐ring cell gastric carcinoma

“…Hematogenous or lymphatic dissemination probably accounts for gastric cancer settling within the skin 2,5,8 . Direct extension of the tumor and iatrogenic surgical implantation might also be responsible for cutaneous metastases 4,9 …”

“…Nodular involvement of umbilical or periumbilical region, known as Sister Mary Joseph's nodule , is the most frequent clinical scenario 7 . Uncommonly, nodules may develop at remote sites such as the scalp, neck, chest, back, breast, axilla, buttock, upper extremity, palm, fingertip, face, pubis, scrotum, or perianal region 5,9 . Cutaneous nodular metastases because of seeding or intraoperative percutaneous implantation at previous trocar, surgical drain, or gastrostomy sites, after curative or palliative resection, have been reported 4,9 .…”

“…Uncommonly, nodules may develop at remote sites such as the scalp, neck, chest, back, breast, axilla, buttock, upper extremity, palm, fingertip, face, pubis, scrotum, or perianal region 5,9 . Cutaneous nodular metastases because of seeding or intraoperative percutaneous implantation at previous trocar, surgical drain, or gastrostomy sites, after curative or palliative resection, have been reported 4,9 . Inflammatory form portrays cutaneous lesions simulating allergic contact dermatitis, erythema annulare centrifugum, figurate erythema, cellulitis or erysipelas ( carcinoma erysipelatoides ), scleroderma ( carcinoma en cuirasse ), and scarring alopecia ( alopecia neoplastica ) 3,5,10 .…”

“…2,5,8 Direct extension of the tumor and iatrogenic surgical implantation might also be responsible for cutaneous metastases. 4,9 Histopathological and immunohistochemical studies assist in establishing definitive diagnosis of cutaneous metastasis and delineating the origin of occult tumor. 1,5,10 The detection of SRCs within the skin can imply either a primary or a secondary malignancy.…”