Bolliet Marine, Green Mary, Damadi Amir
Department of Surgery, Ascension Providence Hospital-Michigan State University College of Human Medicine, Soutfield Campus, 16001 West Nine Mile Road, Southfield, MI 48075, United States.
Michigan State University College of Osteopathic Medicine, East Lansing, MI, United States.
J Surg Case Rep. 2023 Oct 21;2023(10):rjad560. doi: 10.1093/jscr/rjad560. eCollection 2023 Oct.
Gastric adenocarcinoma is a leading cause of mortality worldwide. The most common sites of metastases are the liver, peritoneum, lungs, and bones. Cases have been described in the colon and rectum, but are very rare. This case report describes a patient in remission from diffuse signet ring cell type gastric adenocarcinoma with resection and chemoradiation close to 10 years prior to presenting with a near-obstructing rectal mass that was consistent with metastatic gastric adenocarcinoma. Gastric cancer spreads via hematogenous, lymphatic, peritoneal seeding, or local recurrence pathways. Given the length of time between initial presentation and eventual metastasis, the theory of dormancy is discussed and proposed as a possible cause in the delay of metastasis to the rectum. This highlights the importance of maintaining a high index of suspicion for recurrence and metastasis in a patient with a history of gastric cancer, who presents with a new obstructing rectal mass.
胃腺癌是全球主要的死亡原因之一。最常见的转移部位是肝脏、腹膜、肺和骨骼。虽然有病例报道发生在结肠和直肠，但非常罕见。本病例报告描述了一名患者，该患者曾患弥漫性印戒细胞型胃腺癌，接受手术切除及放化疗后病情缓解，近10年后出现接近梗阻性的直肠肿块，经诊断为转移性胃腺癌。胃癌可通过血行、淋巴、腹膜种植或局部复发途径扩散。考虑到初次发病与最终转移之间的时间间隔，文中讨论并提出了休眠理论，认为这可能是导致转移至直肠延迟的原因。这凸显了对于有胃癌病史且出现新的梗阻性直肠肿块的患者，保持对复发和转移高度怀疑指数的重要性。
