Korean J Gastroenterol.  2014 Jan;63(1):39-41. 10.4166/kjg.2014.63.1.39.

Early Gastric Cancer with Cellulitis-like Skin Metastasis

• Jang YH
• Lim DH
• Kim YH
• Suh WY
• Park KW
• Song IH
• Lee SI

• KMID: 1711304
• DOI: http://doi.org/10.4166/kjg.2014.63.1.39

Abstract

Skin metastasis from internal carcinoma rarely occurs and it has an incidence of 0.7% to 9%. Although the prognosis of the skin metastases varies considerably depending on the type of the primary malignancy, presence of metastatic skin cancer usually implies a widespread systemic disease and a high mortality. A 50-year-old Korean male patient visited Dankook University Hospital for evaluation of skin rash on his whole abdomen of about 1 month's duration. He had undergone laparoscopy-assisted distal gastrectomy due to early gastric cancer about 3 months ago. He did not complain of any noticeable symptoms like febrile sense or pruritus. Skin biopsy was performed on the periumbilical area at previous port site and around the scar. Microscopic examination revealed multiple malignant cells in lymphatic spaces, consistent with metastatic carcinoma. He was therefore diagnosed with isolated skin metastasis from early gastic cancer. Because of patient's poor liver function, systemic chemotherapy could not be performed and only best supportive care was provided. Herein, we report a rare case of cellulitis-like skin metastasis from early gastric cancer with a brief review of the literature.

Keyword

Stomach neoplasms; Neoplasm metastasis; Skin; Gastrectomy

MeSH Terms

Carcinoma/*diagnosis/pathology/surgery
Exanthema
Humans
Keratin-7/metabolism
Laparoscopy
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Positron-Emission Tomography
Skin Neoplasms/metabolism/pathology/secondary
Stomach Neoplasms/*diagnosis/pathology/surgery
Tomography, X-Ray Computed
Keratin-7

Figure

• 

  Fig. 1. Diffuse erythematous cellulitis-like skin rash on whole abdomen.

• 

  Fig. 2. Microscopic findings of the skin biopsy. (A) Malignant cells are seen in lymphatic spaces which is consistent with metastatic adeno-carcinoma (H&E, ×100). (B) Immunohistochemical staining performed on the cells in lymphatic spaces were positive for Pan-CK (×200).

Reference

References

1. Inoue K, Tobe T, Kan N, et al. Problems in the definition and treatment of early gastric cancer. Br J Surg. 1991; 78:818–821.

2. Lai JF, Kim S, Kim K, et al. Prediction of recurrence of early gastric cancer after curative resection. Ann Surg Oncol. 2009; 16:1896–1902.

3. Youn HG, An JY, Choi MG, Noh JH, Sohn TS, Kim S. Recurrence after curative resection of early gastric cancer. Ann Surg Oncol. 2010; 17:448–454.

4. Brownstein MH, Helwig EB. Metastatic tumors of the skin. Cancer. 1972; 29:1298–1307.

5. Saeed S, Keehn CA, Morgan MB. Cutaneous metastasis: a clinical, pathological, and immunohistochemical appraisal. J Cutan Pathol. 2004; 31:419–430.

6. Hussein MR. Skin metastasis: a pathologist's perspective. J Cutan Pathol. 2010; 37:e1–e20.

7. Gunji Y, Suzuki T, Hori S, et al. Prognostic significance of the number of metastatic lymph nodes in early gastric cancer. Dig Surg. 2003; 20:148–153.

8. Brownstein MH, Helwig EB. Patterns of cutaneous metastasis. Arch Dermatol. 1972; 105:862–868.

9. Zivanovic O, Sonoda Y, Diaz JP, et al. The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease. Gynecol Oncol. 2008; 111:431–437.

10. Eng MK, Katz MH, Bernstein AJ, Shikanov S, Shalhav AL, Zorn KC. Laparoscopic port-site metastasis in urologic surgery. J Endourol. 2008; 22:1581–1585.

11. Lehnert T, Erlandson RA, Decosse JJ. Lymph and blood capillaries of the human gastric mucosa. A morphologic basis for metastasis in early gastric carcinoma. Gastroenterology. 1985; 89:939–950.

12. Kobayashi M, Araki K, Matsuura K, Kawai S, Moriki T. Early gastric cancer giving rise to bone and brain metastases–a review of the Japanese literature. Hepatogastroenterology. 2002; 49:1751–1754.