Xue Huimin, Yang Xiaomei, Shen Qing, Qu Jinglei, Qu Xiujuan, Chen Ying
Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China.
Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China; Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China; Liaoning Province Clinical Research Center for Cancer, Shenyang, People's Republic of China; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Hospital of China Medical University, Shenyang, People's Republic of China.
Acta Oncol. 2025 Feb 26;64:312-318. doi: 10.2340/1651-226X.2025.41296.
Rectal metastasis from gastric cancer (GC), also known as Schnitzler's metastasis, is a rare phenomenon. The clinicopathological characteristics, outcomes, and prognostic factors of this condition remain poorly understood.
We describe a case of GC causing Schnitzler's metastasis and present a systematic review on case reports and case series. Data extracted and analyzed include clinicopathological features, treatment modalities received, outcomes, and follow-up.
A total of 34 records, including our own, encompassing 41 cases were incorporated into the study. The median age of patients at admission was 59 years, with females accounting for 53.7% of cases. The predominant histological subtype of Schnitzler's metastasis was moderate-to-poorly differentiated adenocarcinoma, representing 31 cases (86.1%). Among the patients in this cohort, 38.9% exhibited signet-ring cell carcinoma. Regarding the initial diagnosis of GC, 28.6% were categorized as stage IIIA, and 28.6% were classified as stage IV. The median overall survival (OS) time was 72 months (95% confidence interval [CI]: 27-NA), while the median OS since the diagnosis of metastatic cancer was 16 months (95% CI: 9-NA).
Schnitzler's metastasis presents a challenge in the pathology of colorectal endoscopy and may lead to treatment delays. Imaging features such as increased thickness of the intestinal wall and significant layered enhancement can aid in diagnosis; however, deep core biopsy of intestinal lesions remains the gold standard for diagnosing rectal metastases. Accurately distinguishing rectal metastases from primary rectal cancer is crucial for preventing unnecessary therapeutic interventions.
胃癌（GC）的直肠转移，也称为施尼茨勒转移，是一种罕见现象。这种情况的临床病理特征、结局和预后因素仍知之甚少。
我们描述了一例导致施尼茨勒转移的胃癌病例，并对病例报告和病例系列进行了系统综述。提取和分析的数据包括临床病理特征、接受的治疗方式、结局和随访情况。
本研究共纳入34份记录（包括我们自己的），涵盖41例病例。患者入院时的中位年龄为59岁，女性占病例的53.7%。施尼茨勒转移的主要组织学亚型为中低分化腺癌，共31例（86.1%）。在该队列患者中，38.9%表现为印戒细胞癌。关于胃癌的初始诊断，28.6%被归类为IIIA期，28.6%被归类为IV期。中位总生存期（OS）为72个月（95%置信区间[CI]：27 - 无可用数据），而自诊断转移性癌症以来的中位OS为16个月（95% CI：9 - 无可用数据）。
施尼茨勒转移在大肠内镜病理检查中是一项挑战，可能导致治疗延迟。肠壁增厚和显著分层强化等影像学特征有助于诊断；然而，肠道病变的深部核心活检仍然是诊断直肠转移的金标准。准确区分直肠转移与原发性直肠癌对于避免不必要的治疗干预至关重要。
