Korean J Gastroenterol.  2015 Oct;66(4):221-226. 10.4166/kjg.2015.66.4.221.

A Case of Advanced Gastric Cancer Presenting as Multiple Colonic Lymphoid Hyperplasia

• Lee IH
• Lee J
• Byeon SW
• Lee H
• Huo S
• Yoon SB
• Kim JS
• Lee SH
• Roh SY

• KMID: 2373345
• DOI: http://doi.org/10.4166/kjg.2015.66.4.221

Abstract

Gastric cancer frequently disseminates to the liver, lung, and bone via hematogeneous, lymphatic, or peritoneal routes. However, gastric adenocarcinoma that metastasize to the colon and that shows typical linea platisca pattern on colonofiberscopy has rarely been reported. Recently, the authors experience a case of advanced gastric cancer with colonic metastases in a 55-year-old female patient. Multiple colonic lymphoid hyperplasias were detected on colonofiberscopy and biopsy revealed metastatic gastric cancer to the colonic wall. She was treated with mFOLFOX (5-FU, oxaliplatin, leucovorin) and has achieved stable disease status without disease progression. Herein, we report a rare case of signet ring-cell gastric cancer which metastasized to the colon in the form of multiple colonic lymphoid hyperplasias.

Keyword

Stomach neoplasms; Signet ring cell carcinoma; Neoplasm metastasis

MeSH Terms

Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Colonic Neoplasms/*diagnosis/secondary
Colonoscopy
Female
Fluorouracil/administration & dosage
Gastroscopy
Humans
Hyperplasia/diagnosis
Leucovorin/administration & dosage
Middle Aged
Organoplatinum Compounds/administration & dosage
Positron-Emission Tomography
Stomach Neoplasms/*diagnosis/drug therapy
Tomography, X-Ray Computed
Fluorouracil
Leucovorin
Organoplatinum Compounds

Figure

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  Fig. 1. Abdomen CT shows multiple enlarged perigastric lymph nodes (A), aortocaval, paraaortic, and portahe-patis lymph nodes (B). Chest CT shows metastatic supraclavicular lymph nodes (C) and lymphangitic metastasis at right apex (D).

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  Fig. 2. (A, B) Upper endoscopy shows multiple shallow ulcers (arrows) with erythematous change on distal antrum and angle. (C-F) Colonoscopy shows multiple lymphoid hyperplasia from distal colon to rectum.

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  Fig. 3. Biopsy specimens of the stomach and colon. H&E of stomach and colon shows infiltrating adenocarcinoma with signet ring cell feature (A, ×200; B, ×200). On immunohistochemical stain, colon specimen is positive for CK7 (C, ×200), and negative for CK20 (D, ×200) and CDX2 (E, ×200). Immunohistochemical stain of stomach is also positive for CK7 (F, ×200), and negative for CK20 (G, ×200) and CDX2 (H, ×200).

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  Fig. 4. Response evaluation after 3 cycles of mFOLFOX6. (A, B) Upper endoscopy and colonoscopy show improved mucosal friability and decreased mucosal nodularity. (C, D) Chest and abdomen CT scan show stable disease (arrows).

Reference

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