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

Abstract

Background Port site metastasis (PSM) after curative gastrectomy for gastric cancer and muscular metastasis from gastric cancer are rare manifestations. Similarly, subcutaneous metastasis from gastric cancer is rare, and muscular and subcutaneous metastases are associated with poor prognosis. We report a case of long-term survival in a patient who underwent curative resection of gastric cancer and repeated recurrence of port site, muscular and subcutaneous metastases from gastric cancer, treated by resection. Case presentation A 75-year-old man was diagnosed with gastric cancer and referred to our department. Upper endoscopy demonstrated a 5-cm circumferential ulcerated lesion at the cardia. Biopsy findings showed a poorly differentiated tubular adenocarcinoma. He underwent laparoscopic total gastrectomy with lymph node dissection, and pathologic examination revealed a moderately differentiated tubular adenocarcinoma stage T4aN1M0 and IIIA according to the UICC (Union for International Cancer Control) classification. He refused adjuvant chemotherapy and was only carefully observed. Twenty-three months after the primary gastrectomy, computed tomography (CT) revealed an irregular mass near the port site wounds. Then the patient underwent mass resection, and the pathological diagnosis was consistent with metastatic adenocarcinoma, located in the subcutaneous tissue at the port site wounds. Thirteen months after the second surgery, CT revealed an enhanced mass in the abdominal wall. Positron emission tomography (PET) CT showed an elevated uptake in the rectus abdominis muscle and a standardized uptake value (SUV) of 3.1. The patient underwent another mass resection, and the pathological diagnosis was consistent with metastatic adenocarcinoma in the rectus abdominis muscle. Thirty-five months after the third surgery, CT revealed a mass in the left gluteal subcutaneous region. Furthermore, PET-CT revealed a 35-mm mass with an elevated SUV of 9.6. Another mass resection procedure was performed, and the pathological diagnosis was consistent with metastatic adenocarcinoma in the subcutaneous tissue. Since tumor cells were present at the resection margin, additional radiation therapy was performed. The patient has survived 78 months after primary gastrectomy. Conclusion The prognosis of muscular and subcutaneous metastases from gastric cancer is poor. However, if the metastatic tumor is solitary, surgical excision could be a feasible treatment option and might prolong survival.

Port-Site Metastasis After Laparoscopic Gastrectomy Extending to the Thigh: A Case Report

“…There are only five detailed reports of PSM recurrence after curative resection of gastric cancer [3][4][5][6][7] (Table 1). Previous reports demonstrated that PSM mainly arose on the left side, ranging in size from 2.5 to 5 cm.…”

“…Laparoscopic gastrectomy for curative resection is a popular procedure for both early and advanced gastric cancer [2]. Port-site metastasis (PSM) following laparoscopic gastrectomy is rare and has been sporadically reported [3][4][5][6][7]. These reports only documented resected cases for localized PSM; however, these reports have not clarified the clinicopathological features of gastric cancer and their association with the occurrence of PSM, and there are no reports of PSM extending into the skeletal muscles and deteriorating activities of daily living (ADL).…”

Case report: A case of advanced gastric cancer with multiple skin metastases, with significant relief from immunotherapy

“…Gastric cancer is the fifth leading cause of cancer-related deaths worldwide, with a particularly low 5-year survival rate for advanced gastric cancer ( 1 ). Lymph nodes, liver, and peritoneum are common sites of recurrence and metastasis in gastric cancer, while skin metastasis is rare, occurring at a rate of only 0.8-1% ( 2 ). Skin metastasis in gastric cancer mainly occurs through hematogenous and lymphatic spread, and its mechanism is complex and not yet fully understood.…”

Intragastric free cancer cells may be attached to automatic staplers during anastomosis in patients with gastric cancer

“…If intragastric free cancer cells adhere to the automatic stapler, these free cancer cells may come in contact with the laparoscopic port area and progress to port site recurrence. Port site recurrences develop in 0.4–11% of laparoscopic gastrectomies for gastric cancer [ 2 ]. While using an automatic stapler during gastric reconstruction, intragastric free cancer cells may come in contact with the anastomotic line and cause anastomotic recurrence.…”