Cancer Res Treat.  2014 Oct;46(4):415-418. 10.4143/crt.2013.068.

Pleural Metastasis as Initial Presentation of Occult Gastric Cardia Cancer: A Possible Role of PET-CT in Diagnosis

• Yoon SY
• Kim JH
• Kim WS
• Chung HW
• Lee MH
• Kim SY
• Cho YH

• KMID: 2380380
• DOI: http://doi.org/10.4143/crt.2013.068

Abstract

We report on a case of malignant pleural effusion as initial metastatic presentation of occult gastric cardia cancer in a young woman. To the best of our knowledge, this is the first report of gastric adenocarcinoma metastasized to pleura as an initial presentation. Location of cardia and signet ring cell histology may contribute to the manifestation. Utilization of positron emission tomography-computed tomography was helpful for proper diagnosis. For patients with such distinct clinical presentations, it would be appropriate to consider gastric cancer as one of the possible primary sites.

Keyword

Pleura; Cardia; Signet ring cell carcinoma; Positron-emission tomography; Computed tomography

MeSH Terms

Adenocarcinoma
Carcinoma, Signet Ring Cell
Cardia*
Diagnosis*
Electrons
Female
Humans
Neoplasm Metastasis*
Pleura
Pleural Effusion, Malignant
Positron-Emission Tomography
Stomach Neoplasms

Figure

• 

  Fig. 1. (A) Pleural biopsy shows clusters of poorly differentiated carcinoma with signet ring cell features, infiltrating into the skeletal muscle fibers (H&E staining, ×200). (B) The biopsy shows clusters of poorly differentiated carcinoma with signet ring cell features and remaining gastric foveolar epithelium (upper part) (H&E staining, ×200).

• 

  Fig. 2. (A) Mild fludeoxyglucose uptake (maximum standardized uptake value [SUVmax], 4.3) seen at gastric cardia. (B) Larger and more prominent uptake (SUVmax, 8.0) seen four months later.

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  Fig. 3. Endoscopic finding of a patient with ill-defined hyperemic erosions in the cardia at retroflexion view.

Reference

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