Skip to main content
Top
Published in: World Journal of Surgical Oncology 1/2021

01-12-2021 | Metastasis | Case report

Isolated brachioradialis metastasis of gastric adenocarcinoma after R0 resection

Authors: Elizabeth Jacob, Levi Smucker, Ryan Crouse, Ayana Allard-Picou

Published in: World Journal of Surgical Oncology | Issue 1/2021

Login to get access

Abstract

Background

Gastric cancer is the fifth most common cancer worldwide, with an incidence of 6.72 per 100,000 people. Thirty-two percent of gastric cancer patients will live 5 years after diagnosis. Single-site metastasis is noted in 26% of patients with gastric cancer, most commonly in the liver (48%), peritoneum (32%), lung (15%), and bone (12%). Here, a case is presented in which a single skeletal muscle metastasis appeared after appropriate resection and treatment.

Case presentation

A 63-year-old man underwent neoadjuvant chemotherapy and a multivisceral en bloc R0 resection. Final pathology showed no evidence of lymph node metastasis with 31 negative lymph nodes. Four months postoperatively, the patient was found to have a rapidly growing biopsy-proven extremity soft tissue gastric metastasis within the brachioradialis muscle. He subsequently underwent metastasectomy and immunotherapy.

Conclusion

This case is a rare example of an isolated extremity metastasis of gastric adenocarcinoma in the setting of an R0 resection of the primary tumor and negative nodal disease on final pathology, suggestive of hematogenous spread. We review the biology, workup, and management of gastric cancer and highlight new advancements in the treatment of this aggressive cancer.
Literature
6.
go back to reference Sato N, Sawae Y, Fukamachi K. Case of stomach cancer with remote metastases to the entire body, especially to the spleen and bilateral iliopsoas. Naika Intern Med. 1962;9:774–8. Sato N, Sawae Y, Fukamachi K. Case of stomach cancer with remote metastases to the entire body, especially to the spleen and bilateral iliopsoas. Naika Intern Med. 1962;9:774–8.
7.
go back to reference Treves R, Barruch D, Desproges-Gotteron R. Les metastases musculaires. Sem Hop Paris. 1979;55:1471–5. Treves R, Barruch D, Desproges-Gotteron R. Les metastases musculaires. Sem Hop Paris. 1979;55:1471–5.
9.
go back to reference Fujiwara R, Saga T, Akashi N, Takegoshi T, Saitoh K, Tokuda T, Kitoh C, Ichiyanagi K, Doishita K. Heterotopic ossification in the skeletal muscle metastases of advanced stomach cancer. Gan no rinsho Jpn J Cancer Clin. 1983;29(12):1471–5. Fujiwara R, Saga T, Akashi N, Takegoshi T, Saitoh K, Tokuda T, Kitoh C, Ichiyanagi K, Doishita K. Heterotopic ossification in the skeletal muscle metastases of advanced stomach cancer. Gan no rinsho Jpn J Cancer Clin. 1983;29(12):1471–5.
11.
go back to reference Arnold RW, Adams BA, Camoriano JK, Dyer JA. Acquired divergent strabismus: presumed metastatic gastric carcinoma to the medial rectus muscle. J Pediatr Ophthalmol Strabismus. 1989;26(1):50–1.PubMed Arnold RW, Adams BA, Camoriano JK, Dyer JA. Acquired divergent strabismus: presumed metastatic gastric carcinoma to the medial rectus muscle. J Pediatr Ophthalmol Strabismus. 1989;26(1):50–1.PubMed
12.
go back to reference Porile JL, Olopade OI, Hoffman PC. Gastric adenocarcinoma presenting with soft tissue masses. Am J Gastroenterol (Springer Nature). 1990;85(1):76–7. Porile JL, Olopade OI, Hoffman PC. Gastric adenocarcinoma presenting with soft tissue masses. Am J Gastroenterol (Springer Nature). 1990;85(1):76–7.
13.
go back to reference Sudo AK, Ogihara YO, Shiokawa YA, Fujinami SH, Sekiguchi SH. Intramuscular metastasis of carcinoma. Clin Orthop Relat Res. 1993;1(296):213–7. Sudo AK, Ogihara YO, Shiokawa YA, Fujinami SH, Sekiguchi SH. Intramuscular metastasis of carcinoma. Clin Orthop Relat Res. 1993;1(296):213–7.
15.
go back to reference Toillon M, Lepage M, Naudin P, Moreau M, Trutaud-Muresan A, Lamotte A. Muscular metastasis from a gastric adenocarcinoma. Gastroenterol Clin Biol. 1994;18(10):906–7.PubMed Toillon M, Lepage M, Naudin P, Moreau M, Trutaud-Muresan A, Lamotte A. Muscular metastasis from a gastric adenocarcinoma. Gastroenterol Clin Biol. 1994;18(10):906–7.PubMed
16.
go back to reference Amano Y, Kumazaki T. Gastric carcinoma metastasis to calf muscles: MR findings. Radiat Med. 1996;14(1):35–6.PubMed Amano Y, Kumazaki T. Gastric carcinoma metastasis to calf muscles: MR findings. Radiat Med. 1996;14(1):35–6.PubMed
17.
go back to reference Ferri J, Vandenhaute B, Donazzan M. Intra-masseter metastasis of a gastric adenocarcinoma. Rev Stomatol Chir Maxillofac. 1997;98(5):303–5.PubMed Ferri J, Vandenhaute B, Donazzan M. Intra-masseter metastasis of a gastric adenocarcinoma. Rev Stomatol Chir Maxillofac. 1997;98(5):303–5.PubMed
19.
go back to reference Pestalozzi BC, Von Hochstetter AR. Muscle metastasis as initial manifestation of adenocarcinoma of the stomach. Schweiz Med Wochenschr. 1998;128(38):1414–7.PubMed Pestalozzi BC, Von Hochstetter AR. Muscle metastasis as initial manifestation of adenocarcinoma of the stomach. Schweiz Med Wochenschr. 1998;128(38):1414–7.PubMed
20.
go back to reference Pinto F, Falleni A, Campoccia S, Lischi DM. Muscular metastasis of a gastric carcinoma: the first sign of a recurrence of the disease. A case. Radiol Med. 1998;95(6):677–8.PubMed Pinto F, Falleni A, Campoccia S, Lischi DM. Muscular metastasis of a gastric carcinoma: the first sign of a recurrence of the disease. A case. Radiol Med. 1998;95(6):677–8.PubMed
28.
go back to reference Sakuma T, Deguchi R, Takashimizu S, Ogasawara F, Numata M, Ohtani Y, Sato S, Mine T, Iwata Y. Good response chemotherapy for late-recurring gastric cancer in the gluteals, with peritoneal and retroperitoneal dissemination. Tokai J Exp Clin Med. 2011;36(1):8–12.PubMed Sakuma T, Deguchi R, Takashimizu S, Ogasawara F, Numata M, Ohtani Y, Sato S, Mine T, Iwata Y. Good response chemotherapy for late-recurring gastric cancer in the gluteals, with peritoneal and retroperitoneal dissemination. Tokai J Exp Clin Med. 2011;36(1):8–12.PubMed
30.
31.
go back to reference Lourenço LG, Carlotto JR, Herbella FA, Silva DA, Setti HB. Muscular metastasis from gastric cancer. J Gastrointest Oncol. 2014;5(6):E100.PubMedPubMedCentral Lourenço LG, Carlotto JR, Herbella FA, Silva DA, Setti HB. Muscular metastasis from gastric cancer. J Gastrointest Oncol. 2014;5(6):E100.PubMedPubMedCentral
32.
go back to reference Koga Y, Baba Y, Harada K, Kosumi K, Shigaki H, Kurashige J, Ishimoto T, Iwatsuki M, Miyamoto Y, Sakamoto Y, Yoshida N. Multiple skeletal muscle metastases from poorly differentiated gastric adenocarcinoma. Surg Case Rep. 2015;1(1):1–5.CrossRef Koga Y, Baba Y, Harada K, Kosumi K, Shigaki H, Kurashige J, Ishimoto T, Iwatsuki M, Miyamoto Y, Sakamoto Y, Yoshida N. Multiple skeletal muscle metastases from poorly differentiated gastric adenocarcinoma. Surg Case Rep. 2015;1(1):1–5.CrossRef
34.
go back to reference Ebisui C, Hamano R, Nushijima Y, Yanagisawa T, Okamura S, Fukuchi N, Murata K, Yokouchi H, Kinuta M, Ohishi K. A case of T1a early gastric cancer that metastasized to the right femoral muscles six years and seven months after radical surgery. Gan to kagaku ryoho Cancer Chemother. 2016;43(12):1893–5. Ebisui C, Hamano R, Nushijima Y, Yanagisawa T, Okamura S, Fukuchi N, Murata K, Yokouchi H, Kinuta M, Ohishi K. A case of T1a early gastric cancer that metastasized to the right femoral muscles six years and seven months after radical surgery. Gan to kagaku ryoho Cancer Chemother. 2016;43(12):1893–5.
35.
go back to reference Temido H, Vilão F, Parente F. Diplopia as rare initial manifestation of gastric cancer. Acta Med Port. 2017;30(4):339.CrossRefPubMed Temido H, Vilão F, Parente F. Diplopia as rare initial manifestation of gastric cancer. Acta Med Port. 2017;30(4):339.CrossRefPubMed
36.
go back to reference Kamitani N, Watanabe A, Kirihataya Y, Ko S. Metachronous skeletal muscle metastasis without any other organ metastases after curative gastrectomy: a case report. Surg Case Rep. 2018;4(1):1–5.CrossRef Kamitani N, Watanabe A, Kirihataya Y, Ko S. Metachronous skeletal muscle metastasis without any other organ metastases after curative gastrectomy: a case report. Surg Case Rep. 2018;4(1):1–5.CrossRef
37.
go back to reference Aguirre LE, Salcedo J, Zuquello R, Garcia-Buitrago M, Ardalan B. Metastatic involvement of skeletal muscle from gastric adenocarcinoma. Oxf Med Case Rep. 2019;2019(8):omz081.CrossRef Aguirre LE, Salcedo J, Zuquello R, Garcia-Buitrago M, Ardalan B. Metastatic involvement of skeletal muscle from gastric adenocarcinoma. Oxf Med Case Rep. 2019;2019(8):omz081.CrossRef
39.
go back to reference Ajani JAM, D’Amico TA, Bentrem DJ, Chao J, Corvera C, Das P, Denlinger CS, Enzinger PC, Fanta P, Farjah F, Gerdes H, Gibson M, Glasgow RE, Hochwald S, Hofstetter WL, Ilson DH, Johung KL, Keswani RN, Kleinberg LR, Klempner S, Leong S, Ly QP, Matkovskyj KA, McNamara M, Mucahy MF, Paluri RK, Park H, Perry KA, Pimiento J, Poultsides GA, Roses RE, Strong VE, Wiesner G, Willett CG, Yakoub D. National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology: gastric cancer; 2020. Ajani JAM, D’Amico TA, Bentrem DJ, Chao J, Corvera C, Das P, Denlinger CS, Enzinger PC, Fanta P, Farjah F, Gerdes H, Gibson M, Glasgow RE, Hochwald S, Hofstetter WL, Ilson DH, Johung KL, Keswani RN, Kleinberg LR, Klempner S, Leong S, Ly QP, Matkovskyj KA, McNamara M, Mucahy MF, Paluri RK, Park H, Perry KA, Pimiento J, Poultsides GA, Roses RE, Strong VE, Wiesner G, Willett CG, Yakoub D. National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology: gastric cancer; 2020.
41.
go back to reference Tan IB, Ivanova T, Lim KH, Ong CW, Deng N, Lee J, et al. Intrinsic subtypes of gastric cancer, based on gene expression pattern, predict survival and respond differently to chemotherapy. Gastroenterology. 2011;141(2):476–85.e1-11.CrossRefPubMed Tan IB, Ivanova T, Lim KH, Ong CW, Deng N, Lee J, et al. Intrinsic subtypes of gastric cancer, based on gene expression pattern, predict survival and respond differently to chemotherapy. Gastroenterology. 2011;141(2):476–85.e1-11.CrossRefPubMed
42.
go back to reference Sahasrabudhe R, Lott P, Bohorquez M, Toal T, Estrada AP, Suarez JJ, Brea-Fernández A, Cameselle-Teijeiro J, Pinto C, Ramos I, Mantilla A, Prieto R, Corvalan A, Norero E, Alvarez C, Tapia T, Carvallo P, Gonzalez LM, Cock-Rada A, Solano A, Neffa F, Della Valle A, Yau C, Soares G, Borowsky A, Hu N, He LJ, Han XY, Taylor PR, Goldstein AM, Torres J, Echeverry M, Ruiz-Ponte C, Teixeira MR, Carvajal-Carmona LG, Echeverry M, Bohorquez M, Prieto R, Suarez J, Mateus G, Bravo MM, Bolaños F, Vélez A, Corvalan A, Carvallo P, Torres J, Carvajal-Carmona L. Germline mutations in PALB2, BRCA1, and RAD51C, which regulate DNA recombination repair, in patients with gastric cancer. Gastroenterology. 2017;152(5):983–6.e6. https://doi.org/10.1053/j.gastro.2016.12.010.CrossRefPubMed Sahasrabudhe R, Lott P, Bohorquez M, Toal T, Estrada AP, Suarez JJ, Brea-Fernández A, Cameselle-Teijeiro J, Pinto C, Ramos I, Mantilla A, Prieto R, Corvalan A, Norero E, Alvarez C, Tapia T, Carvallo P, Gonzalez LM, Cock-Rada A, Solano A, Neffa F, Della Valle A, Yau C, Soares G, Borowsky A, Hu N, He LJ, Han XY, Taylor PR, Goldstein AM, Torres J, Echeverry M, Ruiz-Ponte C, Teixeira MR, Carvajal-Carmona LG, Echeverry M, Bohorquez M, Prieto R, Suarez J, Mateus G, Bravo MM, Bolaños F, Vélez A, Corvalan A, Carvallo P, Torres J, Carvajal-Carmona L. Germline mutations in PALB2, BRCA1, and RAD51C, which regulate DNA recombination repair, in patients with gastric cancer. Gastroenterology. 2017;152(5):983–6.e6. https://​doi.​org/​10.​1053/​j.​gastro.​2016.​12.​010.CrossRefPubMed
48.
go back to reference Shiao YH, Rugge M, Correa P, Lehmann HP, Scheer WD. p53 alteration in gastric precancerous lesions. Am J Pathol. 1994;144(3):511–7.PubMedPubMedCentral Shiao YH, Rugge M, Correa P, Lehmann HP, Scheer WD. p53 alteration in gastric precancerous lesions. Am J Pathol. 1994;144(3):511–7.PubMedPubMedCentral
52.
go back to reference Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948–57. https://doi.org/10.1016/S0140-6736(18)32557-1.CrossRefPubMed Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948–57. https://​doi.​org/​10.​1016/​S0140-6736(18)32557-1.CrossRefPubMed
53.
go back to reference Fuchs CS, Doi T, Jang RW, Muro K, Satoh T, Machado M, Sun W, Jalal SI, Shah MA, Metges JP, Garrido M, Golan T, Mandala M, Wainberg ZA, Catenacci DV, Ohtsu A, Shitara K, Geva R, Bleeker J, Ko AH, Ku G, Philip P, Enzinger PC, Bang YJ, Levitan D, Wang J, Rosales M, Dalal RP, Yoon HH. Safety and efficacy of pembrolizumab monotherapy in patients with previously treated advanced gastric and gastroesophageal junction cancer: phase 2 clinical KEYNOTE-059 trial. JAMA Oncol. 2018;4(5):e180013. https://doi.org/10.1001/jamaoncol.2018.0013.CrossRefPubMedPubMedCentral Fuchs CS, Doi T, Jang RW, Muro K, Satoh T, Machado M, Sun W, Jalal SI, Shah MA, Metges JP, Garrido M, Golan T, Mandala M, Wainberg ZA, Catenacci DV, Ohtsu A, Shitara K, Geva R, Bleeker J, Ko AH, Ku G, Philip P, Enzinger PC, Bang YJ, Levitan D, Wang J, Rosales M, Dalal RP, Yoon HH. Safety and efficacy of pembrolizumab monotherapy in patients with previously treated advanced gastric and gastroesophageal junction cancer: phase 2 clinical KEYNOTE-059 trial. JAMA Oncol. 2018;4(5):e180013. https://​doi.​org/​10.​1001/​jamaoncol.​2018.​0013.CrossRefPubMedPubMedCentral
54.
go back to reference Brar G, Shah MA. The role of pembrolizumab in the treatment of PD-L1 expressing gastric and gastroesophageal junction adenocarcinoma. Therap Adv Gastroenterol. 2019;12:1756284819869767.CrossRefPubMedPubMedCentral Brar G, Shah MA. The role of pembrolizumab in the treatment of PD-L1 expressing gastric and gastroesophageal junction adenocarcinoma. Therap Adv Gastroenterol. 2019;12:1756284819869767.CrossRefPubMedPubMedCentral
59.
63.
go back to reference Samples JE, Stitzenberg KB, Meyers MO. Lymph node yield and survival in gastric carcinoma. JCO. 2014;32(15_suppl):4012.CrossRef Samples JE, Stitzenberg KB, Meyers MO. Lymph node yield and survival in gastric carcinoma. JCO. 2014;32(15_suppl):4012.CrossRef
67.
go back to reference Miyazaki M, Itoh H, Nakagawa K, Ambiru S, Shimizu H, Togawa A, Shiobara M, Ohtsuka M, Sasada K, Shimizu Y, Yoshioka S, Nakajima N, Suwa T, Kimura F. Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol. 1997;92(3):490–3. Miyazaki M, Itoh H, Nakagawa K, Ambiru S, Shimizu H, Togawa A, Shiobara M, Ohtsuka M, Sasada K, Shimizu Y, Yoshioka S, Nakajima N, Suwa T, Kimura F. Hepatic resection of liver metastases from gastric carcinoma. Am J Gastroenterol. 1997;92(3):490–3.
Metadata
Title
Isolated brachioradialis metastasis of gastric adenocarcinoma after R0 resection
Authors
Elizabeth Jacob
Levi Smucker
Ryan Crouse
Ayana Allard-Picou
Publication date
01-12-2021
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2021
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-021-02191-9

Other articles of this Issue 1/2021

World Journal of Surgical Oncology 1/2021 Go to the issue