Limits...
Scalp metastasis from gastric cancer: A case report and literature review.

DU C, Hong R, Liu Y, Wang J, Zhang H, Yu X - Oncol Lett (2014)

Bottom Line: The patient did not exhibit any rash or plaque at the initial physical examination.The English literature was searched in the PubMed database and four cases of gastric cancer metastatic to the scalp were found.The present report discusses the common clinical presentations of these four cases in combination with the current case.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China.

ABSTRACT

The current report presents an extremely rare case of a 41-year-old female with advanced gastric cancer who developed scalp metastasis during the period of systemic chemotherapy. The patient did not exhibit any rash or plaque at the initial physical examination. Following the 11th cycle of chemotherapy, the patient complained of pain on the scalp and a pink lesion was identified in the parietal region on physical examination, which increased in size and became darker and ulcerated. Pathological biopsy of the lesion and cranial magnetic resonance imaging confirmed the diagnosis of scalp metastasis. The patient succumbed to the disease one month later. The English literature was searched in the PubMed database and four cases of gastric cancer metastatic to the scalp were found. The present report discusses the common clinical presentations of these four cases in combination with the current case.

No MeSH data available.


Related in: MedlinePlus

Midline sagittal T1-weighted image with fat-suppression following administration of contrast agents, captured on January 24, 2011. Image shows heterogeneous thickening of the galea aponeurotica, identified by the star and of the skin on the top of the brain with significant enhancement, as well as the dura mater of the parietal and occipital lobe. Defects are evident in the skin and are indicated by the white arrows. The diploë on the parietal and occipital bone is also shown to be heterogeneously enhanced.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4301561&req=5

f5-ol-09-02-0641: Midline sagittal T1-weighted image with fat-suppression following administration of contrast agents, captured on January 24, 2011. Image shows heterogeneous thickening of the galea aponeurotica, identified by the star and of the skin on the top of the brain with significant enhancement, as well as the dura mater of the parietal and occipital lobe. Defects are evident in the skin and are indicated by the white arrows. The diploë on the parietal and occipital bone is also shown to be heterogeneously enhanced.

Mentions: A 41-year-old female patient was admitted to the Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences (Beijing, China) on July 21, 2010 due to complaints of upper abdominal pain for 10 months and lower back pain for three months. The patient’s Karnofsky Performance Status score was 90. No skin rash or plaque was observed on general physical examination. Multiple enlarged lymph nodes were palpable in bilateral cervical and supraclavicular regions, and chest palpation revealed tenderness over the seventh right rib. The abdomen was soft without palpable organomegaly. No point tenderness was identified under the xiphoid upon palpitation without muscle guarding or rebound tenderness. Complete blood count showed anemia (hemoglobin levels, 102 g/l), biochemistry tests were within the normal ranges and certain serum biomarker levels were elevated (CA19-9, 156.4 U/ml; CA72-4, 1,292 U/ml; CEA, within the normal range). Gastroscopy revealed a 1.0×1.2-cm submucosal lesion along the greater curvature of the gastric body. Pathological biopsy of the gastric lesion showed signet ring cell carcinoma and HER-2 staining was negative in tumor cells. Pathological biopsy of the supraclavicular lymph nodes showed metastatic carcinoma. Computed tomography (CT) scan from the neck to the pelvis revealed enlarged lymph nodes in the cervical, supraclavicular, mediastinal, hilar, perigastric and retroperitoneal regions, in addition to thickening of the gastric wall, bilateral ovarian metastases, pericardial effusion, bilateral pleural effusion and ascites. Radionuclide bone scan showed multiple bone metastases. Based on the previously described observations, the diagnosis of stage IV gastric signet ring cell carcinoma was determined. Between July 2010 and December 2010, the patient received 11 cycles of systemic chemotherapy using docetaxel (40 mg/m2d1), oxaliplatin (85 mg/m2d2) and 5-fluorouracil (400 mg/m2 bolus on days two and three plus 600 mg/m2 continuous intravenous infusion over 22 h on day one, twice every two weeks). During the interval of the second cycle of chemotherapy, the patient received local radiotherapy to the rib metastatic site due to unrelieved pains. The adverse effects of the chemotherapy included grade II gastrointestinal reactions, grade II thrombocytopenia and grade III neutropenia. Following four cycles of chemotherapy, the patient achieved partial response according to the RECIST guidelines (version 1.1) (10) and the results were confirmed following eight cycles. In early December 2010, the patient complained of pain in the scalp. Physical examination revealed a pink lesion measuring 3×3 cm2 on the scalp over the parietal region, with slight tenderness (Fig. 1). Further inquiry into the patient’s past history indicated a similar ‘skin disease’ at the same site several years previously, which had been cured by specific dermatologic drugs. Plain skull magnetic resonance imaging (MRI) scan showed local thickening of the subparietal galea aponeurotica (Fig. 2). The patient refused further examination. The patient’s follow-up at our department for regular chemotherapy found that the scalp lesion had increased in size (12×13 cm2) and become darker and ulcerated (Fig. 3). Therefore, the patient was referred to the dermatology clinic. Pathological biopsy of the lesion revealed tumor emboli in small vessels (Fig. 4). On January 21, 2011, the patient complained of sickness, vertigo and diplopia. The patient was admitted to our emergency room on January 24, 2011, and cranial MRI revealed scalp and dural metastases (Fig. 5). The patient was treated with mannitol and prednisolone to control intracranial hypertension. However, the symptoms were uncontrollable and the patient succumbed to the disease two days later.


Scalp metastasis from gastric cancer: A case report and literature review.

DU C, Hong R, Liu Y, Wang J, Zhang H, Yu X - Oncol Lett (2014)

Midline sagittal T1-weighted image with fat-suppression following administration of contrast agents, captured on January 24, 2011. Image shows heterogeneous thickening of the galea aponeurotica, identified by the star and of the skin on the top of the brain with significant enhancement, as well as the dura mater of the parietal and occipital lobe. Defects are evident in the skin and are indicated by the white arrows. The diploë on the parietal and occipital bone is also shown to be heterogeneously enhanced.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4301561&req=5

f5-ol-09-02-0641: Midline sagittal T1-weighted image with fat-suppression following administration of contrast agents, captured on January 24, 2011. Image shows heterogeneous thickening of the galea aponeurotica, identified by the star and of the skin on the top of the brain with significant enhancement, as well as the dura mater of the parietal and occipital lobe. Defects are evident in the skin and are indicated by the white arrows. The diploë on the parietal and occipital bone is also shown to be heterogeneously enhanced.
Mentions: A 41-year-old female patient was admitted to the Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences (Beijing, China) on July 21, 2010 due to complaints of upper abdominal pain for 10 months and lower back pain for three months. The patient’s Karnofsky Performance Status score was 90. No skin rash or plaque was observed on general physical examination. Multiple enlarged lymph nodes were palpable in bilateral cervical and supraclavicular regions, and chest palpation revealed tenderness over the seventh right rib. The abdomen was soft without palpable organomegaly. No point tenderness was identified under the xiphoid upon palpitation without muscle guarding or rebound tenderness. Complete blood count showed anemia (hemoglobin levels, 102 g/l), biochemistry tests were within the normal ranges and certain serum biomarker levels were elevated (CA19-9, 156.4 U/ml; CA72-4, 1,292 U/ml; CEA, within the normal range). Gastroscopy revealed a 1.0×1.2-cm submucosal lesion along the greater curvature of the gastric body. Pathological biopsy of the gastric lesion showed signet ring cell carcinoma and HER-2 staining was negative in tumor cells. Pathological biopsy of the supraclavicular lymph nodes showed metastatic carcinoma. Computed tomography (CT) scan from the neck to the pelvis revealed enlarged lymph nodes in the cervical, supraclavicular, mediastinal, hilar, perigastric and retroperitoneal regions, in addition to thickening of the gastric wall, bilateral ovarian metastases, pericardial effusion, bilateral pleural effusion and ascites. Radionuclide bone scan showed multiple bone metastases. Based on the previously described observations, the diagnosis of stage IV gastric signet ring cell carcinoma was determined. Between July 2010 and December 2010, the patient received 11 cycles of systemic chemotherapy using docetaxel (40 mg/m2d1), oxaliplatin (85 mg/m2d2) and 5-fluorouracil (400 mg/m2 bolus on days two and three plus 600 mg/m2 continuous intravenous infusion over 22 h on day one, twice every two weeks). During the interval of the second cycle of chemotherapy, the patient received local radiotherapy to the rib metastatic site due to unrelieved pains. The adverse effects of the chemotherapy included grade II gastrointestinal reactions, grade II thrombocytopenia and grade III neutropenia. Following four cycles of chemotherapy, the patient achieved partial response according to the RECIST guidelines (version 1.1) (10) and the results were confirmed following eight cycles. In early December 2010, the patient complained of pain in the scalp. Physical examination revealed a pink lesion measuring 3×3 cm2 on the scalp over the parietal region, with slight tenderness (Fig. 1). Further inquiry into the patient’s past history indicated a similar ‘skin disease’ at the same site several years previously, which had been cured by specific dermatologic drugs. Plain skull magnetic resonance imaging (MRI) scan showed local thickening of the subparietal galea aponeurotica (Fig. 2). The patient refused further examination. The patient’s follow-up at our department for regular chemotherapy found that the scalp lesion had increased in size (12×13 cm2) and become darker and ulcerated (Fig. 3). Therefore, the patient was referred to the dermatology clinic. Pathological biopsy of the lesion revealed tumor emboli in small vessels (Fig. 4). On January 21, 2011, the patient complained of sickness, vertigo and diplopia. The patient was admitted to our emergency room on January 24, 2011, and cranial MRI revealed scalp and dural metastases (Fig. 5). The patient was treated with mannitol and prednisolone to control intracranial hypertension. However, the symptoms were uncontrollable and the patient succumbed to the disease two days later.

Bottom Line: The patient did not exhibit any rash or plaque at the initial physical examination.The English literature was searched in the PubMed database and four cases of gastric cancer metastatic to the scalp were found.The present report discusses the common clinical presentations of these four cases in combination with the current case.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing 100021, P.R. China.

ABSTRACT

The current report presents an extremely rare case of a 41-year-old female with advanced gastric cancer who developed scalp metastasis during the period of systemic chemotherapy. The patient did not exhibit any rash or plaque at the initial physical examination. Following the 11th cycle of chemotherapy, the patient complained of pain on the scalp and a pink lesion was identified in the parietal region on physical examination, which increased in size and became darker and ulcerated. Pathological biopsy of the lesion and cranial magnetic resonance imaging confirmed the diagnosis of scalp metastasis. The patient succumbed to the disease one month later. The English literature was searched in the PubMed database and four cases of gastric cancer metastatic to the scalp were found. The present report discusses the common clinical presentations of these four cases in combination with the current case.

No MeSH data available.


Related in: MedlinePlus