Metastatic involvement of skeletal muscle from gastric adeno
Gastric cancer is the fifth most common cancer diagnosis reported worldwide and the third leading cause of cancer-related mortality. The most common sites of metastasis are the liver (48%) and peritoneum (32%). Other sites include the lung (15%), bone (12%), lymph nodes and adrenal gland. Skeletal muscle involvement has been rarely reported.

A 57-year-old Hispanic female with history of T3N1M0 poorly differentiated signet ring cell type adenocarcinoma of the GEJ, presented in late December 2018 with worsening abdominal and left lower-extremity pain. She had been treated initially in 2008 with two cycles of neoadjuvant DCF (docetaxel, cisplatin and 5FU) followed by total gastrectomy with D2 lymphadenectomy and roux-en-y reconstruction.

Pathology done at that time showed a 10.5 cm poorly differentiated mucinous adenocarcinoma with transmural extension and invasion of the serosa and perigastric adipose tissue. One in 27 lymph nodes was positive. She underwent adjuvant chemoradiation with capecitabine and had an uneventful follow-up. She was in remission until December 2017 at which time she was noted to have ascites and hematochezia. Findings on paracentesis were consistent with peritoneal carcinomatosis. Follow-up colonoscopy showed colonic and rectal erosions with biopsies returning as metastatic poorly differentiated gastric adenocarcinoma.

Source: Oxford Medical Case Reports

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