Limits...
Uncommon mucosal metastases to the stomach

Kanthan R, Sharanowski K, Senger JL, Fesser J, Chibbar R, Kanthan SC - World J Surg Oncol (2009)

Bottom Line: Poorly differentiated adenocarcinoma of the lung was demonstrated in a subsequent biopsy of "gastric polyps".Biopsies of the colonic and gastric mucosa demonstrated moderately differentiated invasive colonic adenocarcinoma with metastatic deposits in the stomach.While the accurate recognition of these lesions at endoscopy is fraught with difficulty, pathological awareness of such uncommon metastases in the gastric mucosa is essential for accurate diagnosis and optimal patient management.

Affiliation: Department of Pathology & Laboratory Medicine, College of Medicine, Saskatoon, Saskatchewan, Canada. rani.kanthan@saskatoonhealthregion.ca

ABSTRACT

Background: Metastases to the stomach from an extra-gastric neoplasm are an unusual event, identified in less than 2% of cancer patients at autopsy. The stomach may be involved by hematogenous spread from a distant primary (most commonly breast, melanoma or lung), or by contiguous spread from an adjacent malignancy, such as the pancreas, esophagus and gallbladder. These latter sites may also involve the stomach via lymphatic or haematogenous spread. We present three cases of secondary gastric malignancy.

Methods/results: The first is a 19-year-old male who received a diagnosis of testicular choriocarcinoma in September 2004. Metastatic malignancy was demonstrated in the stomach after partial gastrectomy was performed to control gastric hemorrhage. The second is a 75-year-old male, generally well, who was diagnosed with adenocarcinoma of the lung in September 2005. Poorly differentiated adenocarcinoma of the lung was demonstrated in a subsequent biopsy of "gastric polyps". The third is an 85-year-old man with no known history of malignancy who presented for evaluation of iron deficiency anemia by endoscopy in February 2006. Biopsies of the colonic and gastric mucosa demonstrated moderately differentiated invasive colonic adenocarcinoma with metastatic deposits in the stomach.

Conclusion: While the accurate recognition of these lesions at endoscopy is fraught with difficulty, pathological awareness of such uncommon metastases in the gastric mucosa is essential for accurate diagnosis and optimal patient management.

Histopathology of the Pleural Biopsy Hematoxylin and eosin stained, low power magnification ×150. A. Pleural biopsy confirming the presence of black triangle – atypical neoplastic cells infiltrating the fibro connective tissue and adipose tissue of the pleura. The inset in the bottom left shows positive immunohistochemical staining with TTF1 supporting primary lung carcinoma. B. Pleural fluid demonstrates the presence of atypical cells with a high nucleus cytoplasmic ratio supporting a neoplastic lesion. C. Mucosal biopsy of the stomach showing the presence of large atypical malignant cells in the vascular channels with ↑ – enlarged hyperchromatic pleomorphic nuclei consistent with poorly differentiated carcinoma from the lung.
© Copyright Policy - open-access

Figure 3: Histopathology of the Pleural Biopsy Hematoxylin and eosin stained, low power magnification ×150. A. Pleural biopsy confirming the presence of black triangle – atypical neoplastic cells infiltrating the fibro connective tissue and adipose tissue of the pleura. The inset in the bottom left shows positive immunohistochemical staining with TTF1 supporting primary lung carcinoma. B. Pleural fluid demonstrates the presence of atypical cells with a high nucleus cytoplasmic ratio supporting a neoplastic lesion. C. Mucosal biopsy of the stomach showing the presence of large atypical malignant cells in the vascular channels with ↑ – enlarged hyperchromatic pleomorphic nuclei consistent with poorly differentiated carcinoma from the lung.

Mentions: A right-sided pleural biopsy as seen in figure 3A illustrates the fibroconnective and adipose tissue of the pleura infiltrated by atypical cells (black triangle) with ample cytoplasm, large, hyperchromatic nuclei, irregular nuclear membranes and prominent nucleoli. The cells have ample cytoplasm, some of which appear to have vacuoles with prominent desmoplasia. Immunohistochemically, these cells were positive for pankeratin, TTF-1 (shown as insert), Ber-EP4 and CEA; they were negative for calretinin, cytokeratin 5 and 6, S100 and Melan-A. The cytological examination of the pleural fluid (figure 3B) demonstrates atypical cells with a high nuclear-to-cytoplasmic ratio suspicious for an underlying malignant neoplasm.

View Similar Images In: Results  - Collection
View Article: Medline Plus - Pubmed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2734526&rFormat=json&query=null&req=5
Uncommon mucosal metastases to the stomach

Kanthan R, Sharanowski K, Senger JL, Fesser J, Chibbar R, Kanthan SC - World J Surg Oncol (2009)

Histopathology of the Pleural Biopsy Hematoxylin and eosin stained, low power magnification ×150. A. Pleural biopsy confirming the presence of black triangle – atypical neoplastic cells infiltrating the fibro connective tissue and adipose tissue of the pleura. The inset in the bottom left shows positive immunohistochemical staining with TTF1 supporting primary lung carcinoma. B. Pleural fluid demonstrates the presence of atypical cells with a high nucleus cytoplasmic ratio supporting a neoplastic lesion. C. Mucosal biopsy of the stomach showing the presence of large atypical malignant cells in the vascular channels with ↑ – enlarged hyperchromatic pleomorphic nuclei consistent with poorly differentiated carcinoma from the lung.
© Copyright Policy
Figure 3: Histopathology of the Pleural Biopsy Hematoxylin and eosin stained, low power magnification ×150. A. Pleural biopsy confirming the presence of black triangle – atypical neoplastic cells infiltrating the fibro connective tissue and adipose tissue of the pleura. The inset in the bottom left shows positive immunohistochemical staining with TTF1 supporting primary lung carcinoma. B. Pleural fluid demonstrates the presence of atypical cells with a high nucleus cytoplasmic ratio supporting a neoplastic lesion. C. Mucosal biopsy of the stomach showing the presence of large atypical malignant cells in the vascular channels with ↑ – enlarged hyperchromatic pleomorphic nuclei consistent with poorly differentiated carcinoma from the lung.
Mentions: A right-sided pleural biopsy as seen in figure 3A illustrates the fibroconnective and adipose tissue of the pleura infiltrated by atypical cells (black triangle) with ample cytoplasm, large, hyperchromatic nuclei, irregular nuclear membranes and prominent nucleoli. The cells have ample cytoplasm, some of which appear to have vacuoles with prominent desmoplasia. Immunohistochemically, these cells were positive for pankeratin, TTF-1 (shown as insert), Ber-EP4 and CEA; they were negative for calretinin, cytokeratin 5 and 6, S100 and Melan-A. The cytological examination of the pleural fluid (figure 3B) demonstrates atypical cells with a high nuclear-to-cytoplasmic ratio suspicious for an underlying malignant neoplasm.

Bottom Line: Poorly differentiated adenocarcinoma of the lung was demonstrated in a subsequent biopsy of "gastric polyps".Biopsies of the colonic and gastric mucosa demonstrated moderately differentiated invasive colonic adenocarcinoma with metastatic deposits in the stomach.While the accurate recognition of these lesions at endoscopy is fraught with difficulty, pathological awareness of such uncommon metastases in the gastric mucosa is essential for accurate diagnosis and optimal patient management.

Affiliation: Department of Pathology & Laboratory Medicine, College of Medicine, Saskatoon, Saskatchewan, Canada. rani.kanthan@saskatoonhealthregion.ca

ABSTRACT

Background:

Background: Metastases to the stomach from an extra-gastric neoplasm are an unusual event, identified in less than 2% of cancer patients at autopsy. The stomach may be involved by hematogenous spread from a distant primary (most commonly breast, melanoma or lung), or by contiguous spread from an adjacent malignancy, such as the pancreas, esophagus and gallbladder. These latter sites may also involve the stomach via lymphatic or haematogenous spread. We present three cases of secondary gastric malignancy.

Methods/results: The first is a 19-year-old male who received a diagnosis of testicular choriocarcinoma in September 2004. Metastatic malignancy was demonstrated in the stomach after partial gastrectomy was performed to control gastric hemorrhage. The second is a 75-year-old male, generally well, who was diagnosed with adenocarcinoma of the lung in September 2005. Poorly differentiated adenocarcinoma of the lung was demonstrated in a subsequent biopsy of "gastric polyps". The third is an 85-year-old man with no known history of malignancy who presented for evaluation of iron deficiency anemia by endoscopy in February 2006. Biopsies of the colonic and gastric mucosa demonstrated moderately differentiated invasive colonic adenocarcinoma with metastatic deposits in the stomach.

Conclusion: While the accurate recognition of these lesions at endoscopy is fraught with difficulty, pathological awareness of such uncommon metastases in the gastric mucosa is essential for accurate diagnosis and optimal patient management.

View Similar Images In: Results  - Collection
View Article: Medline Plus - Pubmed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2734526&rFormat=json&query=null&req=5