Jayal Mehta, DO, Ifreah Usmaiel, MD, Aboud Affi, MD Aurora Health Care, Milwaukee, WI
Introduction: Signet-ring gastric cancer is an aggressive type of gastric cancer distinguished by mucin producing cells, which most commonly arises from the stomach. The incidence of signet-ring cell carcinoma (SRCC) is steadily increasing, accounting for 35% to 45% of gastric adenocarcinoma cases in recent studies. Presentation of metastatic lesions of SRCC with colon strictures is rare, with most common site of metastasis being peritoneum and lymph nodes. The prognosis of SRCC is poor, in large part due to its more advanced stage at presentation.
Case Description/Methods: A 34-year-old previously healthy female was evaluated in GI clinic for nausea and vomiting during pregnancy, suspected to be related to hyperemesis gravidum. After delivery, she was seen in GI clinic, with persistent emesis and diffuse abdominal pain. Upper endoscopy was notable for reactive gastropathy with no obvious finding suggestive of gastric outlet obstruction or dysmotility. Omeprazole and nortriptyline provided minimal relief.
When symptoms persisted after multiple emergency department and PCP visits, CT scan was done showing diffuse gastric wall thickening, suspected be related to gastritis. Gastric carcinoma was considered unlikely given the uniform nature of the thickening in the absence of strictures. On repeat visit with GI, she reported objective weight loss of over 100 lbs. Additional workup with EGD and colonoscopy, with EGD revealing linitis plastica. Colonoscopy at the same time revealed very tight and narrow area in the distal sigmoid colon, able to be transversed only with gastric endoscope. Biopsies from both gastric and sigmoid colon revealed invasive poorly differentiated adenocarcinoma with signet cell ring features, compatible with gastric primary.
Discussion: Gastric cancer is the fifth common and the third most deadly neoplasm globally. Despite the decrease in incidence of gastric cancer in the past decade related to improvement in diagnosis and treatment of H. Pylori, incidence of signet-ring gastric cancer has been increasing. Advanced stage at time of diagnosis leads to high mortality. It has a propensity to metastasize to lymph nodes and distant organs, with metastasis to colon being rare. Our patient had both a delay in diagnosis and she was noted to have metastatic disease with colonic stricture, an extremely rare site of metastasis for signet cell adenocarcinoma.
Figure: Linitis plastica on upper endoscopy
Jayal Mehta indicated no relevant financial relationships.
Ifreah Usmaiel indicated no relevant financial relationships.
Aboud Affi indicated no relevant financial relationships.
Jayal Mehta, DO, Ifreah Usmaiel, MD, Aboud Affi, MD. P2084 - Rare Case of Gastric Adenocarcinoma With Metastasis to Colon at the Time of Diagnosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.