A Rare Initial Presentation of Gastric Cancer with Multiple Osteolytic Lesions (original) (raw)
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Scholarly Research Exchange, 2009
We present a 68-year-old male with leptomeningeal carcinomatosis (LC) from gastroesophageal junction carcinoma. Three months following epirubicin, cisplatin, 5-flurouracil (ECF) chemotherapy, the patient suffered from gait imbalance, headache, and dysarthria. CT and MRI imaging revealed LC throughout the brain and spine. The patient was prescribed dexamethasone and treated with a course of palliative radiation to the whole brain, 2000cGy/5. Additionally, the regions of symptomatic disease in the spine included the top of L4 vertebrae to the bottom of the S2 vertebrae which was treated with 2000cGy/5, and the top of the C5 vertebrae to the bottom of the T4 vetebrae received 800cGy/1. The radiation treatment did provide short-term symptom control; however, the patient eventually passed away from his illness. While LC remains a devastating complication of malignant disease, it has been rarely discussed in GI tumors, specifically GE junction adenocarcinomas. Therefore treatment options must be considered using first principles based on management of LC in more common disease sites. With early detection, and for patients with good performance status, palliative radiation utilizing hypofractionated regimens to sites of symptomatic involvement may improve quality of life for this group of unfortunate people.
Annals of Surgical Treatment and Research, 2014
The aim of this study is to investigate the clinical features and outcomes of 9 consecutive patients who suffered with leptomeningeal carcinomatosis (LMC) originating from gastric cancer. Methods: Between January 1995 and December 2010, we retrospectively reviewed the medical records of 9 patients with gastric LMC who had been treated at St. Vincent's Hospital, The Catholic University of Korea. Results: With the exception of 1 patient, the primary gastric cancer was Borrmann type III or IV, and 5 cases had poorly differentiated or signet ring cell histology. TNM stage of the primary gastric cancer was III in 6 patients. The median interval from diagnosis of the primary malignancy to the diagnosis of LMC was 9 months. Headache (6 cases), altered mental status (4 cases), and dysarthria (3 cases) were presenting symptoms of LMC. Computed tomography findings were abnormal in 4 of 7 cases, while magnetic resonance imaging revealed abnormality in 4 of 5 cases. Radiation therapy was administered to 5 patients and intrathecal chemotherapy was administered to only 1 patient. Median overall survival duration from the diagnosis of LMC was 3 months. Conclusion: LMC originating from gastric cancer had a fatal clinical course and treatment strategies remain challenging.
Leptomeningeal Carcinomatosis in Gastric Cancer
Journal of Neuro-Oncology, 2000
We analyzed 19 cases of cytologically confirmed leptomeningeal carcinomatosis (LMC) treated at our institution over the past 11 years. LMC was the initial manifestation of gastric cancer in 2 patients. With the exception of 1 patient, the primary gastric cancer was Borrmann type III or IV, and 88% had poorly differentiated or signet-ring cell histology. The gastric cancer was progressive or a recurrent disease in most of the patients. The distribution of extraneural metastasis suggested that Batson's venous plexus might be the predominant route to the subarachnoid space. Eighty percent of the patients had multiple neuraxis syndrome, and the combination of brain plus cranial nerve syndrome was the most common manifestation. Computed tomography (CT) findings were abnormal in a minor proportion of the patients, while magnetic resonance imaging (MRI) revealed abnormality in 67% of the patients, which could help the diagnosis. LMC complicating gastric cancer was ultimately fatal. Median survival was very short, 4 weeks. By univariate analysis, good performance status, intrathecal chemotherapy, and low CSF LDH concentration favored survival. Multivariate analysis revealed that the administration of CSF chemotherapy was the independent prognostic factor for survival.
Leptomeningeal carcinomatosis associated with gastric cancer
International journal of clinical oncology / Japan Society of Clinical Oncology, 2011
BACKGROUND: Leptomeningeal carcinomatosis (LMC) is a rare but devastating complication of gastric cancer. METHODS: The subjects were 12 gastric cancer patients who were diagnosed as having LMC at the Shizuoka Cancer Center between October 2002 and March 2009. We conducted a retrospective survey of the medical records of the study subjects and collected data on the clinical features, treatment modalities employed/outcomes, and survival of the patients. RESULTS: Of the 12 patients, 9 (75%) were male, and the median age was 63 years. Histopathologically, the majority of the patients (83%) had diffuse-type adenocarcinoma. At the time of diagnosis of the LMC, the other major sites of metastasis were the peritoneum (75%) and lymph nodes (50%). The median duration from the diagnosis of gastric cancer to the diagnosis of LMC was 15.6 months. While the treatment strategy changed with time, intrathecal chemotherapy (n = 10), followed by whole brain irradiation (n = 7) and subsequent ventricul...
Gastric carcinoma with osteoblastic differentiation
International Journal of Surgery Case Reports, 2012
a b s t r a c t INTRODUCTION: Carcinosarcoma is a rare malignant biphasic tumor which has sarcomatous and carcinomatous components. Stomach localization is very rare. We discuss the diagnosis, follow-up and treatment of patients diagnosed with gastric carcinosarcoma in company with the literature review.
Osteoblastic metastasis from signet ring cell gastric cancer in a young male
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2014
Bone metastasis is common in patients with lung, prostate, and breast cancers but it isn't common in stomach cancer. Gastric carcinoma infrequently metastasizes to the bone and rarely in an osteoblastic form. Herein we presented a rare case of signet ring cell gastric adenocarcinoma in early stage with osteoblastic metastasis. To our knowledge our case was the youngest signet cell gastric cancer patient with osteoblastic bone metastasis reported in literature.
Bone metastasis as the first sign of gastric cancer
Pan African Medical Journal, 2017
The skeleton is a common metastatic site for visceral carcinomas. However, the presentation of gastric cancer as bony metastases without preceding gastrointestinal symptoms is rare which has been infrequently reported in the literature. We report an infrequent case of a 60-year-old patient diagnosed having a gastric carcinoma with bone metastasis as the first evidence. She has consulted with worsening backache which started two months priorly.
Ring Cell Gastric Cancer Presenting with Headache
2017
Headache, the most common symptom of cerebral dysfunction caused by leptomeningeal carcinomatosis, may be the only symptom. The headache usually results from increased intracranial pressure. Brain metastasis of gastric cancer in particular is rarely encountered and leptomeningeal carcinomatosis (LMC) is even less common. Presentation with isolated headache is a very rare condition in patients with gastric carcinoma. This 48-year-old man was admitted to the neurology outpatient clinic with headache that was present for nearly one month. The pain was felt in entire head particularly in the occipital and neck regions. The nature of the pain was throbbing, which worsened in the morning while the patient was in supine position. His headache persisted for all day. There was no nausea and vomiting. Neurological examination was normal. Brain MRI (contrast-enhanced) demonstrated triventricular hydrocephaly with transependymal edema. MR angiography and venography were also normal. Lumbar punc...
Vertebral carcinomatosis eleven years after advanced gastric cancer resection: A case report
Oncology Letters, 2014
Bone metastasis is an uncommon event in advanced gastric cancer patients and bone metastases are rarely detected as isolated lesions. However, eleven years after treatment for locally advanced gastric cancer, including total gastrectomy followed by adjuvant chemotherapy, a 49-year-old female was admitted to the IX Division of General Surgery of the Second University of Naples (Naples, Italy) exhibiting severe progressive neurological symptoms. Magnetic resonance imaging indicated vertebral abnormalities, with evidence of marrow infiltration in several vertebral bodies; however, a contrast-enhanced computed tomography scan did not detect disease progression to other sites. Biopsy of the soft tissue at the level of the second lumbar vertebra (L2) revealed a metastatic lesion derived from gastric mucinous adenocarcinoma. The patient was initially treated with radiotherapy directed to the L2-L4 vertebral bodies to control the pain. Subsequently, systemic chemotherapy according to a FOLFOX-4 (leucovorin, fluorouracil and oxaliplatin) regimen commenced. However, after eight cycles, pulmonary progression of the disease occurred. Thus, palliative care was administered and the patient succumbed one month later. The late relapse of gastric cancer in the current patient may be associated with the theory of tumour dormancy.
A Fulminant Case of Leptomeningeal Carcinomatosis Secondary to Esophageal Adenocarcinoma
Journal of Gastrointestinal Cancer, 2015
Leptomeningeal carcinomatosis (carcinomatous meningitis) (LC) is a rare complication of solid cancers or hematologic malignancies. LC secondary to gastrointestinal solid tumors is rare [1]. LC frequency due to metastatic esophageal adenocarcinoma is 0.25 % [1]. Case Presentation A 46-year-old male patient presented with a 1-month history of solid food dysphagia and accompanying weight loss. His family history was negative. His physical examination was normal. A distal 1/3 esophageal mass was found on endoscopy and PET CT. He received 3 cycles of chemotherapy consisting of docetaxel, cisplatin, and capecitabine prior to his operation. He complained of tinnitus during this period, which was attributed to a side effect of chemotherapy. He was operated 1 month after the chemotherapy. Pathology revealed a moderately differentiated lymphadenopathypositive adenocarcinoma (T3 N3 M0). His chemotherapy was initiated post-operatively; he received 2 cycles of docetaxel, carboplatin, and capecitabine.