Metachronous metastasis to the stomach from a primary colon cancer: A case report

Abstract

Significance: Metastatic neoplasm in the stomach from remote primary tumor is uncommon. Globally, there have only been less than 20 reported cases of gastric metastases from colon cancer. One post-mortem study reported only 0.8% of colon cancer that has metastasized to the stomach.

Clinical Presentation: We have a 55-year-old male with descending colon adenocarcinoma who underwent left hemicolectomy in 2018. In the same year he underwent chemotherapy with capecitabine and oxaliplatin. A few months after an unremarkable abdominal CT two years post-treatment he complained of a month-long duration of epigastric pain for which he sought consult.

Management: On admission, upper GI tract endoscopy was done which showed a huge friable fungating mass noted at the proximal corpus extending to the distal corpus. The antrum was not completely visualized due to the mass, precluding the visualization of the pyloric ring. Immunohistochemical studies were positive for CK20, SATB2, CDX-2, and negative for CK7. He was signed out as a case of metastatic adenocarcinoma with a colonicprimar.

Recommendation: Diagnosis is dependent on a high index of suspicion plus imaging to evaluate lesions, possibly endoscopy, especially when presenting in a solitary manner after successful resection of a primary malignancy. Immunohistochemistry aids in the diagnosis. A holistic approach in managementis essential, with a median survival of 21 months.