Gastric metastasis presenting as submucosa tumors from renal cell carcinoma:A case report

BACKGROUND Gastric metastasis from renal cell carcinoma(RCC) is an extremely rare clinical entity.Due to an easily neglected RCC history,nonspecific symptoms and underrecognized endoscopic presentation may lead to a potential diagnostic pitfall in daily clinical practice.CASE SUMMARY We present a case of metastatic gastric tumors arising from RCC 5 years after radical nephrectomy.Simultaneous,multifocal metastases to the gallbladder,pancreas and soft tissue were observed.One year previously,a solitary submucosal discoid tumor with a central depression was detected in the gastric fundus in a 65-year-old man.Endoscopic ultrasonography(EUS) showed a 1.12 x 0.38 cm lesion originating from the deeper mucosal layers with partially discontinuous submucosa.One year later,the endoscopic findings of the lesion showed various changes.A large lesion of the protruding type(2.5 cm × 2 cm) was found in the fundus at the same location.EUS showed a heterogeneous mass that involved the mucosa and submucosal layer.In addition,two small similar submucosal lesions 0.4-0.6 cm in size were detected.These lesions had a central depression,surface mucosal congestion and thickened vessels.The two adjacent lesions in the fundus were resected by endoscopic submucosal dissection.Based on the postoperative pathological analysis,the patient was diagnosed with gastric metastasis from RCC.CONCLUSION Gastric metastasis from RCC should be considered in patients with a history of RCC irrespective of the time interval involved.

Metastatic gastric cancer from breast carcinoma presenting with paraneoplastic rheumatic syndrome:A case report

BACKGROUND Breast cancer is the most frequently diagnosed cancer worldwide.It is the leading cause of death by malignant disease in women.CASE SUMMARY A female patient,73 years of age,sought care due to weakness,mild abdominal pain,arthralgia,and weight loss.She was taking anastrazole as maintenance therapy for localized breast cancer and had moderate anemia and elevated acutephase markers.Upper digestive endoscopy showed isolated erosion in the gastric corpus.This lesion was compatible with signet-ring cell adenocarcinoma in anatomopathological study and was confirmed as metastasis of a breast carcinoma in immunohistochemistry,which was positive for estrogen antibody.Further imaging studies determined numerous proximal bone metastases.The patient was treated with prednisone for paraneoplastic syndrome,which improved the anemia and rheumatic disease,and with chemotherapy,which greatly improved the symptoms.She has been followed-up for 6 mo,and her anemia,arthralgias,and acute phase markers have normalized.CONCLUSION Systemic treatment strategies seem to be the best choice for gastric metastasis from breast cancer,resulting in disease control and relapse-free survival.Prospective studies with longer follow-up are needed to better understand the biological,pathological,and clinicopathological characteristics and outcomes of the endoscopic features associated with metastatic gastric cancer from breast carcinoma.

Positive association of RhoC gene overexpression with tumour invasion and lymphatic metastasis in gastric carcinoma

Worldwide estimates establish gastric carcinoma as the second most frequent cause of cancer deaths. Tumour invasion and metastasis is the biggest impediment to gastric carcinoma cure. Active migration of tumour cells is now considered as the pivotal step in cancer invasion and metastasis. RhoC is a member of the Ras-superfamily of small guanosine triphosphatases that can regulate many cellular functions, especially cytoskeletal organization and cell locomotion. Overexpressing RhoC in vitro in the poorly metastatic cell line from human melanoma may induce a highly metastatic phenotype.~1 The recent development of laser capture microdissection (LCM) affords the opportunity to further evaluate the role RhoC plays in the invasion and metastasis of gastric carcinoma cells in their native tissue environment.

COMPARATIVE PATHOLOGICAL AND FCM STUDIES ON THE PRIMARY AND METASTATIC CANCERS IN STOMACH AND BREAST

Pathological morphology,differentiation,cellular DNA content and cell Proliferation index(PI) were comparatively studied in the primary and their corresponding metastatic lesions of 54 cases of gastric and breast cancers- The results showed that differentiation and types of metastatic cancers were in accordance with their corresponding primary cancers in more than half cases(18/13) of stomach cancers,differences could be found in the other cases(16/34),and among them,10 were lower and 6 were higher differentially than their corresponding primary cancers.Similar results were found in breast cancer cases.Flow cytometry(FCM) analysis revealed that dramatic DNA Index(DI) differences between metastatic and their corresponding primary cancers existed in 6/34 of gastric and 4/18 of mammary cancers,among them 7 cases were higher than the primary while 3 were lower than the primary(DI).Similar results could also be found in PI analysis.All these suggested that metastasis of gastric and breast cancer was a very complicated process and metastatic cancer did not necessarily always show lower differentiation,higher DNA contents and DNA aneuploidy as well as higher cell proliferative rate.

Breast cancer metastasis to the stomach

Aim: This study focuses on the stomach as an unusual but not rare site of metastasis of breast cancer. Methods: We performed a literature search on gastric metastasis from breast cancer searching for reviews from 2000 to 2018 and case reports from 2013 to 2018. We found 11 reviews and 36 case reports and we compared their findings about important aspects of gastric metastasis, such as disease free survival, overall survival, symptoms, endoscopic findings, therapy, histology, and immunohistochemistry. Results: The incidence of stomach as site of metastasis of breast cancer ranges from 5% to 18%. Reviews and case reports reached similar conclusions about several of the aforementioned aspects: invasive lobular breast cancer (ILC) is mainly responsible for gastric metastases;disease free survival can vary greatly ranging from 0.5 months to 30 years;gastric metastases usually present with non-specific symptoms, even though five patients in case reports were asymptomatic;linitis plastica is the most common endoscopic finding;immunohistochemistry is essential for differentiating primary gastric cancer from metastasis;the preferred treatment is systemic therapy, but surgery is still an option in case of emergency;median overall survival of patients with gastric metastasis from breast cancer is 24 months. Conclusion: Breast metastasis to the stomach should be considered in any patient suspecting gastric neoplasm previously treated for breast carcinoma, especially if the treated carcinoma was ILC.