Nova Southeastern University College of Allopathic Medicine Foster City, CA, United States
Parvir S. Aujla, BS1, Rohit Khanna, DO2, Alex Prevallet, DO2, Gauree G. Konijeti, MD, MPH3 1Nova Southeastern University College of Allopathic Medicine, Davie, FL; 2Scripps Mercy Hospital, San Diego, CA; 3Scripps Clinic, La Jolla, CA
Introduction: Signet ring cell carcinoma, a rare subset of gastric cancer, is an adenocarcinoma known for its aggressive course and poor prognosis. Patients are typically diagnosed at late stages with nodal or distant metastasis, commonly to the lymph nodes and the peritoneum. We report a rare presentation of gastric SRCC (GSRCC) with multiple ulcerated metastatic masses to the colon.
Case Description/Methods: A previously healthy 50-year-old man presented with 2-months of nausea, solid-food dysphagia, abdominal bloating, loose stools, shortness of breath, and 12 pound weight loss. He reported recent mild bright red blood on the stool, but denied fevers, night sweats, heartburn, or NSAID use. On initial video visit, patient exhibited pallor and abdominal distension without tenderness to self-palpation. He denied history of gastrointestinal disease or previous endoscopy. Laboratory testing showed LDH 557, alkaline phosphatase 1449, AST 113, ALT 127, total bilirubin 0.3, INR 1.3, ferritin 676, and hemoglobin 12.7. EGD showed class A esophagitis and a large ulcerated friable and firm sessile mass extending from GE junction along the lesser curvature of the stomach to the proximal antrum. Colonoscopy showed multiple large friable ulcerated masses, 1 to 5 cm in size, causing localized luminal narrowing throughout the colon. Biopsies from gastric and colonic masses demonstrated GSRCC without H. pylori gastritis. Subsequent CT abdomen/pelvis with IV contrast showed esophageal and gastric wall thickening, retroperitoneal lymphadenopathy, large-volume abdominal/pelvic ascites, and sclerotic lytic bone lesions in C7 and T8. Abdominal paracentesis cytology showed high-grade malignant cells, consistent with metastatic SRCC. The patient is currently receiving palliative treatment with leucovorin, fluorouracil, oxaliplatin, and nivolumab.
Discussion: Colonic metastases of GSRCC are rare, with only 14 case reports identified in literature review. Potential mechanisms include hematogenous, lymphatic, and luminal implantation. Depending on stage, treatment for GSRCC includes endoscopic therapies, radical gastrectomy with lymph node dissection, and/or fluorouracil-based chemotherapies. The overall 5-year survival of stage IV disease is 10.2%. Further research is needed to identify GSRCC early in hopes of limiting tumor spread and morbidity.
Figure: Colonic Metastases from Gastric Signet Ring Cell Carcinoma
Disclosures: Parvir Aujla indicated no relevant financial relationships. Rohit Khanna indicated no relevant financial relationships. Alex Prevallet indicated no relevant financial relationships. Gauree Konijeti indicated no relevant financial relationships.
Parvir S. Aujla, BS1, Rohit Khanna, DO2, Alex Prevallet, DO2, Gauree G. Konijeti, MD, MPH3. P2047 - A Rare Case of Multiple Ulcerated Colonic Masses Due to Metastatic Gastric Signet Ring Cell Carcinoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
