Diagnosis of gastric adenocarcinoma by a subcutaneous metastasis

The patient is a 67-year-old male who consulted for a 3-cm subcutaneous epigastric tumor. As it was believed to be a soft tissue tumor, a biopsy was taken under local anesthesia (Fig. 1). The result showed a metastatic adenocarcinoma of gastric-biliary-pancreatic origin (non-encapsulated proliferation of pleomorphic epithelial cells forming rows). The CT extension study identified a gastric tumor. Gastroscopy and PET (Fig. 2) confirmed an infiltrating gastric adenocarcinoma with a diffuse pattern originating from a single initial metastasis. After initial CTx treatment, total D2 gastrectomy and metastasectomy were performed out of protocol: ypT3N2(3/17)M1. Currently the patient has survived >2 years since diagnosis.

Fig. 1

Fig. 2

Diagnosis

Diffuse-pattern infiltrating gastric adenocarcinoma ypT3N2(3/17)M1, diagnosed after debut of a single subcutaneous metastasis.

Acknowledgements

The authors would like to thank Dr Salomé Martínez, Dr Míriam Gené and Dr Luisa Díaz for their work with the pathology study.

Thanks also go to Dr Sandra Merino and Dr Marta Sant for their assessment of the complexity of the chemotherapy treatment.

Also, Dr Jordi Elvira and Dr Mario Franco, who participated in the surgery, as well as Joan Ferreres, Carles Olona, Laia Adalid and Rosa Jorba, who participated in the composition of the article.