Shima Takafumi, Arita Asami, Sugimoto Satoshi, Takayama Shoichi, Kawaguchi Nao, Imai Yoshiro, Kitahara Tomohiro, Maeda Tamaki, Okuda Junji
Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan.
Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Surg Case Rep. 2023 Mar 17;9(1):39. doi: 10.1186/s40792-023-01622-x.
Although distant metastasis in gastric cancer can be present at the time of the initial diagnosis, colonic metastasis is extremely rare. This report describes a case of simultaneous colonic metastasis of advanced gastric cancer.
The patient was a 78-year-old woman with nausea and epigastric pain. Upper gastrointestinal endoscopy revealed an advanced invasive ulcerative tumor in the lesser curvature of the stomach extending from the anterior to the middle portion. Colonoscopy revealed a 4-mm polyp-like lesion in the mid-transverse colon; therefore, a polypectomy was performed. Both gastric and colonic tumors showed poorly differentiated adenocarcinoma with signet ring cell carcinoma. After providing informed consent, the patient underwent a total gastrectomy. Histologic examination showed similar morphologic features of both gastric and colonic tumors. Immunohistochemistry staining showed that these tumor cells were positive for cytokeratin (CK) 7 and negative for CK20.
This was an extremely rare case of simultaneous colonic metastasis of advanced gastric cancer. Because missed metastasis can result in a poorer prognosis, we propose a systemic search including colonoscopy for patients with advanced gastric cancer, especially cases involving poorly differentiated adenocarcinoma or signet ring cell carcinoma.
尽管胃癌在初次诊断时可能已出现远处转移，但结肠转移极为罕见。本报告描述了一例晚期胃癌同时发生结肠转移的病例。
患者为一名78岁女性，有恶心和上腹部疼痛症状。上消化道内镜检查显示胃小弯处有一个从前部延伸至中部的晚期浸润性溃疡性肿瘤。结肠镜检查发现横结肠中部有一个4毫米的息肉样病变；因此进行了息肉切除术。胃和结肠肿瘤均显示为低分化腺癌伴印戒细胞癌。在获得知情同意后，患者接受了全胃切除术。组织学检查显示胃和结肠肿瘤具有相似的形态学特征。免疫组织化学染色显示这些肿瘤细胞细胞角蛋白（CK）7呈阳性，CK20呈阴性。
这是一例极为罕见的晚期胃癌同时发生结肠转移的病例。由于漏诊转移可能导致预后较差。我们建议对晚期胃癌患者进行包括结肠镜检查在内的全面检查，尤其是对于低分化腺癌或印戒细胞癌患者。
