LETTERS TO THE EDITOR

 

Colonic metastasis of diffuse signet ring cells gastric carcinoma

Metástasis colónicas de carcinoma gástrico difuso en células de anillo de sello

 

 

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Key words: Gastric cancer. Colonic metastases.

Palabras clave: Cáncer gástrico. Metástasis colónicas.

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Dear Editor,

The gastric cancer, despite its remarkable decline in incidence (1), still remains as one of the leading causes of death around the world (2) (7.2 to 20 deaths per 10⁵ inhabitants per year) (3). The diffuse type (according to Lauren's classification) with signet ring cells occasional presence, is less frequent but with worse prognosis than the intestinal, both commonly spread out via haematic and lymphatic (40-60%), (4), and being able to affect organs such as the liver (35-50%), lung (9-22%), bone (1,9%), and central nervous system (0,5-2%); being exceptional, without references, the involvement of other organs such as the colon, as in the case of the patient we report.

 

Case report

This was a 58-year-old male with a history of thalassemia minor, sleep apnea and intervened by Nissen fundoplication due to the alterations of the intestinal transit, pruritus, anal sphincter disorders, and iron-deficiency anaemia. Among the tests that were carried out, colonoscopy demonstrated several ulcerated, vegetating, irregular, hard and brittle lesions located in the ileocecal valve, ascending colon and rectosigmoid junction. The pathology report indicated moderately differentiated adenocarcinoma infiltrating the cecum, colon, sigmoid, and rectum. By endoscopy, it could be seen at the lower curvature of the stomach a large excavated ulcer of 4 cm from which biopsy was taken with the diagnosis of diffuse adenocarcinoma with signet ring cells.

Given these findings (Fig. 1), we contacted with the Department of General Surgery and a surgical intervention was programmed by performing total gastrectomy with D2 lymphadenectomy, splenectomy plus subtotal colectomy with ileorectal and jejunal esophagus anastomosis. The pathological study from the surgical specimens was informed as signet ring cells diffuse gastric carcinoma with metastasis to the small and large intestines (Fig. 2), lymphatic dissemination at the celiac trunk, gastric curvature and periintestinal.

 

 

In the postoperative period, highlighted the presence of a subphrenic abscess and right pleural effusion, which required drainage by interventional radiology. Upon a month of entry, the patient was discharged from revision care and was registered for the nutrition, surgery and oncology service, where he received palliative chemotherapy -preplacement of a reservoir- with cisplatin, a weekly dose during the period of one month. He died upon completing a year of post-surgery.

 

Discussion

In our country, the annual incidence of gastric cancer is estimated to be at around 15-20 cases per 10⁵ inhabitants per year (8.6% of all new cases of cancer). The most common form of presentation is adenocarcinoma of the bowel type variant (3,5). The histological diffuse form (according to Lauren-Ming classification) with signet ring cells such as the one showing by our patient corresponds to the 3 to 39% of all gastric cancers (6), is known to affect young people with predominant blood group A, with no association with premalignant lesions, low relation to environmental factors, badly differentiated and displaying a higher lymphatic impairment (7). Colonic impairment is exceptional by haematological dissemination (8), as in the case we have described. We have found scarce references on this topic.

 

María Luisa Reyes-Díaz, Cristina Torres-Arcos, Fernando Oliva-Mompeán,
Antonio Curado-Soriano, Claudio José Lizarralde-Gómez and Francisco Cuaresma-Soriano
Clinical Management Unit. Hospital Universitario Virgen Macarena. Sevilla, Spain

 

References

1. Powel DG, Kelsen DP, Shah MA. Advanced gastric cancer - Slow but steady progress. Cancer Treat Rev 2010;36:384-92.         [ Links ]

2. Csendes A, Burdiles P, Braghetto I, Díaz J, Maluenda F, Korn O, et al. Resecabilidad y mortalidad operatoria de la gastrectomía subtotal y total en pacientes con cáncer gástrico avanzado, entre 1969 y 2004. Rev Med Chile 2006;134:426-32.         [ Links ]

3. Parkin M, Bray F, Ferlay J, Pisani P. Global Cancer Statistics, 2002. CA Cancer J Clin 2005;55:74-108.         [ Links ]

4. Motoori M, Takemasa I, Doki Y, Saito S, Miyata H, Takiguchi S, et al. Prediction of peritoneal metastasis in advanced gastric cancer by gene expression profiling of the primary site. Eur J Cancer 2006;42:1897-903.         [ Links ]

5. Chiu CT, Kuo CJ, Yeh TS, Hsu JT, Liu KH, Yeh CN, et al. Early Signet Ring Cell Gastric Cancer. Dig Dis Sci 2011;56:1749-56.         [ Links ]

6. Tapia O, Gutiérrez V, Roa JC, Manterola C, Villaseca M, Araya JC. Carcinoma de células en anillo de sello gástrico: Descripción clínico-morfológica y valor pronóstico. Rev Chil Cirugía 2010;62:458-64.         [ Links ]

7. Venturelli F, Cárcamo C, Venturelli A, Cárcamo A, Born M, Jara C, et al. Survival of patients with signet ring cell carcinoma of the stomach, compared with patients with non ring cell gastric cancer. Rev Chil Cirugía 2008;60:398-402.         [ Links ]

8. Lee HC, Lin KY, Tu HY, Zhang TA, Chen PH. Metastases from Gastric Carcinoma to in the form of Multiple Flat Elevated Lesions: a case report. J Med Sci 2004;20;11:552-7.         [ Links ]