Chonnam Med J.  2013 Dec;49(3):133-135. 10.4068/cmj.2013.49.3.133.

A Case of Gastric Cancer Manifesting as a Solitary Brain Metastasis in the Cerebellopontine Angle That Mimicked Acoustic Neuroma

• Joo HY
• Chae MH
• Lim JH
• Yi HG
• Lee MH
• Kim CS
• Park YH

• KMID: 2048819
• DOI: http://doi.org/10.4068/cmj.2013.49.3.133

Abstract

At the time of diagnosis, about 20% of patients with gastric cancer have stage IV disease involving the liver, lung, and bone. Brain metastasis from gastric cancer is exceedingly rare, with an incidence of <1% of clinical cases. A 59-year-old man was admitted with hearing loss in the left ear and left facial palsy for 1 month. A magnetic resonance imaging scan revealed a tumor in the cerebellopontine angle that extended to the inner auditory canal and that was clinically diagnosed as acoustic neuroma. After complete resection, histological examination showed metastatic poorly differentiated carcinoma. Further investigation revealed advanced gastric cancer involving the antrum with no evidence of the involvement of other sites except the brain parenchyma. Palliative total gastrectomy was performed and the surgical specimen revealed a poorly cohesive carcinoma that was histopathologically identical to that of the resected brain tumor. Here we report this rare case of gastric cancer that initially presented as a solitary brain metastasis mimicking acoustic neuroma.

Keyword

Stomach Neoplasms; Brain; Neuroma, Acoustic

MeSH Terms

Acoustics*
Brain Neoplasms
Brain*
Cerebellopontine Angle*
Diagnosis
Ear
Facial Paralysis
Gastrectomy
Hearing Loss
Humans
Incidence
Liver
Lung
Magnetic Resonance Imaging
Middle Aged
Neoplasm Metastasis*
Neuroma, Acoustic*
Stomach Neoplasms*

Figure

• 

  FIG. 1 Preoperative T2-weighted brain magnetic resonance images (MRI) showed a 1.5×1 cm sized enhancing mass (arrow) in the left cerebellopontine angle extended to left inner auditory canal.

• 

  FIG. 2 Micrograph of surgical specimens from resected brain tumor (A) and stomach (B) revealed a poorly cohesive carcinoma (H&E stain, ×100).

Reference

1. Lee HJ, Yang HK, Ahn YO. Gastric cancer in Korea. Gastric Cancer. 2002; 5:177–182.

2. York JE, Stringer J, Ajani JA, Wildrick DM, Gokaslan ZL. Gastric cancer and metastasis to the brain. Ann Surg Oncol. 1999; 6:771–776.

3. Go PH, Klaassen Z, Meadows MC, Chamberlain RS. Gastrointestinal cancer and brain metastasis: a rare and ominous sign. Cancer. 2011; 117:3630–3640.

4. Zhang S, Wang M, Xue YH, Chen YP. Cerebral metastasis from hepatoid adenocarcinoma of the stomach. World J Gastroenterol. 2007; 13:5787–5793.

5. Kasakura Y, Fujii M, Mochizuki F, Suzuki T, Takahashi T. Clinicopathological study of brain metastasis in gastric cancer patients. Surg Today. 2000; 30:485–490.

6. Lee HG, Lee B, Kim SM, Suh BJ, Yu HJ. A case of gastric adenocarcinoma presenting as meningeal carcinomatosis. Korean J Intern Med. 2007; 22:304–307.

7. Nakabayashi H, Murata K, Sakaguchi M, Nakajima K, Katsuyama J. Choroid plexus metastasis from gastric cancer--case report. Neurol Med Chir (Tokyo). 1994; 34:183–186.

8. Satoh H, Okhi T, Momma T, Saito S, Niizeki H, Hirose S, et al. Penile skin metastasis of gastric carcinoma associated with prostate carcinoma: a case report. Nihon Hinyokika Gakkai Zasshi. 2001; 92:628–631.

9. Shimoyama S, Seto Y, Aoki F, Ogawa T, Toma T, Endo H, et al. Gastric cancer with metastasis to the gingiva. J Gastroenterol Hepatol. 2004; 19:831–835.

10. Puri T, Gunabushanam G, Sharma DN, Julka PK. Distant metastases as primary presentation of gastric cancer: report of 3 cases. J HK Coll Radiol. 2005; 8:59–62.