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Polypoid colonic metastases from gastric stump carcinoma: A case report.

Gao B, Xue X, Tai W, Zhang J, Chang H, Ma X, Qi Y, Cui L, Yan F, Pan L - Oncol Lett (2014)

Bottom Line: Biopsy specimens excised from the stomach showed a poorly-differentiated adenocarcinoma with diffuse signet ring cells, and a colonoscopy-guided biopsy revealed a signet ring cell adenocarcinoma.The patient succumbed to upper gastrointestinal hemorrhage and pneumonia after three months.A differential diagnosis is required in this complicated situation.

View Article: PubMed Central - PubMed

Affiliation: Department of Gerontology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China.

ABSTRACT
The present study aimed to investigate polypoid colonic metastases from gastric stump carcinoma by performing a retrospective analysis of the clinical data of a patient with such a diagnosis, and by discussing other previous case studies from the literature. The patient of the present study was an 80-year-old male who had undergone a gastrectomy 48 years previously for a benign perforated gastric ulcer. A colonoscopy revealed >10 multiple polypoid lesions of 6-10 mm in diameter distributed throughout the entire colon, except in the rectum. Each lesion had either erosion or a depression at the top and several were covered with a white fur-like substance. Biopsy specimens excised from the stomach showed a poorly-differentiated adenocarcinoma with diffuse signet ring cells, and a colonoscopy-guided biopsy revealed a signet ring cell adenocarcinoma. The patient was referred to the Oncology unit (Beijing Shijitan Hospital, Beijing, China) for assessment and chemotherapy treatment, which was initiated with 1,000 mg Xeloda orally administered twice a day for two-week courses every three weeks. The patient succumbed to upper gastrointestinal hemorrhage and pneumonia after three months. Gastric or gastric stump carcinoma may metastasize to the colon presenting as solitary or multiple colonic polyps. Thus, it is important to consider this diagnosis as such colon metastases may mimic solitary or multiple colonic polyps, which are commonly observed. A differential diagnosis is required in this complicated situation.

No MeSH data available.


Related in: MedlinePlus

Immunohistochemical staining for CK7 and CK20 in gastric stump mucosa showing (A) CK7+ and (B) CK20+ staining (magnification, ×200). CK, cytokeratin.
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f4-ol-08-03-1119: Immunohistochemical staining for CK7 and CK20 in gastric stump mucosa showing (A) CK7+ and (B) CK20+ staining (magnification, ×200). CK, cytokeratin.

Mentions: Gastroscopy detected multifocal ulcerated lesions in the remnant stomach from the cardia (Fig. 1A) to the gastrointestinal anastomosis (Fig. 1B), however, the boundaries of certain lesions were unclear. Colonoscopy revealed that >10 multifocal polypoid lesions measuring 6–10 mm in diameter were scattered throughout the entire colon, except in the rectum (Fig. 2A, transverse colon; and Fig. 2B, descending colon). Each lesion had either erosion or a depression at the top, and several were covered with a white fur-like substance. Abdominal magnetic resonance imaging revealed diffuse thickening of the remnant stomach wall and multiple enlarged lymph nodes on the lesser curvature and retroperitoneum. The biopsy specimens from the stomach showed a poorly-differentiated adenocarcinoma with scattered signet ring cells (Fig. 3A), and the colonoscopy-guided biopsy revealed a signet ring cell adenocarcinoma (Fig. 3B). Immunohistochemical staining of the gastric stump mucosa (Fig. 4A and B) and colon mucosa (Fig. 5A and B) was positive for cytokeratin (CK)7 and CK20. Thus, the actual colonic lesions were corresponding with the mucosal spread of the primary gastric carcinoma.


Polypoid colonic metastases from gastric stump carcinoma: A case report.

Gao B, Xue X, Tai W, Zhang J, Chang H, Ma X, Qi Y, Cui L, Yan F, Pan L - Oncol Lett (2014)

Immunohistochemical staining for CK7 and CK20 in gastric stump mucosa showing (A) CK7+ and (B) CK20+ staining (magnification, ×200). CK, cytokeratin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4114702&req=5

f4-ol-08-03-1119: Immunohistochemical staining for CK7 and CK20 in gastric stump mucosa showing (A) CK7+ and (B) CK20+ staining (magnification, ×200). CK, cytokeratin.
Mentions: Gastroscopy detected multifocal ulcerated lesions in the remnant stomach from the cardia (Fig. 1A) to the gastrointestinal anastomosis (Fig. 1B), however, the boundaries of certain lesions were unclear. Colonoscopy revealed that >10 multifocal polypoid lesions measuring 6–10 mm in diameter were scattered throughout the entire colon, except in the rectum (Fig. 2A, transverse colon; and Fig. 2B, descending colon). Each lesion had either erosion or a depression at the top, and several were covered with a white fur-like substance. Abdominal magnetic resonance imaging revealed diffuse thickening of the remnant stomach wall and multiple enlarged lymph nodes on the lesser curvature and retroperitoneum. The biopsy specimens from the stomach showed a poorly-differentiated adenocarcinoma with scattered signet ring cells (Fig. 3A), and the colonoscopy-guided biopsy revealed a signet ring cell adenocarcinoma (Fig. 3B). Immunohistochemical staining of the gastric stump mucosa (Fig. 4A and B) and colon mucosa (Fig. 5A and B) was positive for cytokeratin (CK)7 and CK20. Thus, the actual colonic lesions were corresponding with the mucosal spread of the primary gastric carcinoma.

Bottom Line: Biopsy specimens excised from the stomach showed a poorly-differentiated adenocarcinoma with diffuse signet ring cells, and a colonoscopy-guided biopsy revealed a signet ring cell adenocarcinoma.The patient succumbed to upper gastrointestinal hemorrhage and pneumonia after three months.A differential diagnosis is required in this complicated situation.

View Article: PubMed Central - PubMed

Affiliation: Department of Gerontology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China.

ABSTRACT
The present study aimed to investigate polypoid colonic metastases from gastric stump carcinoma by performing a retrospective analysis of the clinical data of a patient with such a diagnosis, and by discussing other previous case studies from the literature. The patient of the present study was an 80-year-old male who had undergone a gastrectomy 48 years previously for a benign perforated gastric ulcer. A colonoscopy revealed >10 multiple polypoid lesions of 6-10 mm in diameter distributed throughout the entire colon, except in the rectum. Each lesion had either erosion or a depression at the top and several were covered with a white fur-like substance. Biopsy specimens excised from the stomach showed a poorly-differentiated adenocarcinoma with diffuse signet ring cells, and a colonoscopy-guided biopsy revealed a signet ring cell adenocarcinoma. The patient was referred to the Oncology unit (Beijing Shijitan Hospital, Beijing, China) for assessment and chemotherapy treatment, which was initiated with 1,000 mg Xeloda orally administered twice a day for two-week courses every three weeks. The patient succumbed to upper gastrointestinal hemorrhage and pneumonia after three months. Gastric or gastric stump carcinoma may metastasize to the colon presenting as solitary or multiple colonic polyps. Thus, it is important to consider this diagnosis as such colon metastases may mimic solitary or multiple colonic polyps, which are commonly observed. A differential diagnosis is required in this complicated situation.

No MeSH data available.


Related in: MedlinePlus