Clin Endosc.  2018 Jan;51(1):95-98. 10.5946/ce.2017.049.

Gastric Adenocarcinoma with Systemic Metastasis Involving the Intraocular Choroid and Duodenum

Affiliations
  • 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. stomachlee@gmail.com
  • 2Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Gastric cancer with double metastasis to the orbit and duodenum is extremely rare. We report the case of a patient with gastric adenocarcinoma who presented with synchronous orbital and duodenal metastases at the time of initial diagnosis. A 60-year-old man presented with a 1-month history of visual disorder and pain in his right eye. He underwent ophthalmological examinations. The biopsy results suggested intraocular metastatic carcinoma. We conducted a systemic evaluation to identify primary malignancy. Finally, a diagnosis of advanced gastric adenocarcinoma with multi-organ metastasis was made. He planned to be treated with systemic chemotherapy.

Keyword

Stomach neoplasms; Orbital metastasis; Duodenal metastasis

MeSH Terms

Adenocarcinoma*
Biopsy
Choroid*
Diagnosis
Drug Therapy
Duodenum*
Humans
Middle Aged
Neoplasm Metastasis*
Orbit
Stomach Neoplasms
Vision Disorders

Figure

  • Fig. 1. (A) Wide-field fluorescein angiogram showing hyperfluorescence in the late venous phases with leakage at the tumor border (arrow). (B) Wide-field fundus photograph showing a choroidal mass with associated exudative retinal detachment at the inferior area, without abnormal pigmentation. (C) Optical coherence tomography scan showing shaggy photoreceptors (arrow), “lumpy-bumpy” appearance of a retinal pigment epithelium (arrowhead), and retinal detachment with subretinal fluid, involving the fovea center. (D) Ultrasonography scan showing a polygonal choroidal mass with solid consistency, 22.8×5.5 mm in size, on A-scan (arrow). The B-scan shows high irregular reflectivity (arrowhead). (E) Computed tomography scan showing wall thickening of the medial side of the right eye (arrow), with enhancement. (F) Magnetic resonance imaging scan showing wall thickening of the medial side of the right eye. The T1-weighted image shows isointensity with enhancement, and the T2-weighted image shows hypointensity.

  • Fig. 2. (A) 18F-Fluorodeoxyglucose-positron emission tomography (18-FDG-PET) scan showing increased FDG uptake at the right eyeball (arrow). (B) 18-FDG-PET scan showing multiple hypermetabolic lesions in the stomach, lymph nodes, liver, and bone. (C) Computed tomography scan showing advanced gastric cancer with ulceration at the cardia (arrow).

  • Fig. 3. Esophagogastroduodenoscopy image. (A) An ulceroinfiltrative gastric cancer, 3 cm in size, at the lesser curvature side of the cardia. (B) No mucosal lesion on the antrum. (C) Three slightly elevated round lesions on the second portion of the duodenum.

  • Fig. 4. (A) Endoscopic biopsy specimen from the stomach, showing moderately differentiated tubular adenocarcinoma (hematoxylin-eosin [H&E] staining, original magnification ×100). (B) Endoscopic biopsy specimen from the duodenum, showing a poorly differentiated tubular adenocarcinoma (H&E staining, original magnification ×100).


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