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Eine 57-jahrige Patientin wurde aufgrund eines stetigen Hamoglobinabfalls bis auf 7,4 g/dl einer Gastroskopie unterzogen, nachdem eine Woche zuvor bei einem ischamischen Hirninsult eine systemische Thrombolysetherapie durchgefuhrt worden war. Es zeigten sich multiple kleine Erosionen im Korpusbereich. Die histopathologischen und immunhistochemischen Befunde aus der Magenschleimhautbiopsie mit Expression von „thyroid transcriptional factor-1“ (TTF‑1) und Zytokeratin 7 (CK7) sowie Negativitat fur „caudal type homeobox-2“ (CDX‑2) ergaben eine Metastase eines gering differenzierten Adenokarzinoms der Lunge. In der Computertomographie des Thorax zeigten sich eine 3,2 cm grose, mediastinale Raumforderung mit hochgradigem Verdacht auf Malignitat und pathologisch vergroserte zervikale und supraklavikulare Lymphknoten beidseits. Es erfolgte eine subklavikulare Lymphknotenexstirpation. Der immunhistologische Befund mit positiver CK7- und TTF-1-Expression sprach ebenfalls fur metastatische Infiltrate eines gering differenzierten Adenokarzinoms pulmonalen Ursprungs. Die symptomatische gastrale Metastase eines primaren Lungenkarzinoms ist eine sehr seltene klinische Entitat. Der Befund der transosophagealen Echokardiographie mit Perikarderguss und 1,6 cm groser Auflagerung an der Mitralklappe deutete nach Ausschluss einer infektiosen Endokarditis auf eine maligne Ursache. In Zusammenschau der multiplen Organinfarkte (Milz, Nieren und Hirn) und der gastralen hamatogenen Metastasen gehen wir von einer endokardialen Metastase aus, die als seltene Ursache zu einer disseminierten arteriellen Tumorembolie fuhrte. Die Patientin wurde palliativ betreut und verstarb.

Gastrointestinal metastasis could be considered in the differential diagnosis of melena in the patient with NSCLC history.

Merkel Cell Carcinoma (MCC) is a rare dermatologic malignancy with propensity for metastasis to lymph nodes, skin, lung, liver, bone, and brain. Metastasis to the stomach is rare with only 13 reported cases. We discuss the outcomes of a partial gastrectomy for the treatment of symptomatic MCC with gastric metastasis.

Pancreatic cancer with gastrointestinal tract metastasis is a fairly rare occurrence, and gastric metastasis in such cases has been seldom reported. We herein present a case of gastric involvement secondary to pancreatic cancer in a 74-year-old woman in whom the metastatic lesion only presented as mucosal erosion in the stomach. The patient had a 1-month history of progressive right upper quadrant pain before admission. Computed tomography and endoscopic examinations revealed a solid and hypo-enhancing mass in the head of the pancreas. The patient underwent conventional upper endoscopy before pancreatic biopsy, and mucosal erosion was observed in the gastric pylorus. We obtained gastric and pancreatic biopsies by gastroscopy and endoscopic ultrasound-guided fine needle aspiration, respectively. Pathologically, the biopsies taken from the area of gastric erosion showed poorly differentiated invasive adenocarcinoma that was morphologically consistent with the pancreatic specimens. Moreover, the gastric section showed tumor thrombi within the vessels. Hence, the suspected diagnosis was unresectable pancreatic cancer with gastric metastasis. The patient immediately underwent two courses of chemotherapy, but her condition rapidly deteriorated and she died 2 months later.

Breast cancer is the most common cancer in women, and the leading cause of cancer-related deaths worldwide. Despite advances in screening and treatment modalities, distant metastasis still develops. Breast cancer metastasis to the gastrointestinal tract is very rare, therefore, its diagnosis, therapeutic strategies, and prognosis pose a clinical problem for clinicians. We summarize the current knowledge regarding the clinicopathological characteristics and diagnostic strategies for metastatic tumors in the stomach of breast origin.

The most frequent sites of breast cancer metastasis are the bone, lung and liver. Metastasis to the gastrointestinal tract, central nervous system and adrenal glands are rare, the gastrointestinal tract more frequently with being affected by lobular breast cancer metastasis, and rarely by ductal breast cancer. The case reports a 52-year-old female patient, previously diagnosed with locally advanced ductal breast carcinoma - cT4N+M0, who received neoadjuvant chemotherapy, followed by modified radical mastectomy – ypT2N3aM0 – and adjuvant radiotherapy. During follow-up there were no signs of recurrence, but the patient experienced several episodes of sub-acute intestinal obstruction, which resolved with medical treatment. In 2017, January the patient had another intestinal obstruction, but this time a laparotomy was performed, and two small bowel metastasis were found, which were resected. The pathologic exam revealed metastasis from ductal breast cancer. In the article have we discussed the patterns of breast cancer metastasis, with special consideration for gastrointestinal tract.

Gastric metastasis from ovarian cancer has rarely been reported. We herein report the case of a 64-year-old woman with gastric metastasis from ovarian cancer that was diagnosed as surgical stage IA. Diagnostic and staging laparotomy showed mucinous carcinoma of the right ovary. At one month after surgery, bone metastasis was detected via scintigraphy. On esophagogastroduodenoscopy, a 10-mm elevated lesion with ulceration on the top was seen in the stomach. The immunohistochemical analysis of biopsy specimens showed that these metastases arose from ovarian cancer. We recommend that physicians remain aware of the possibility of gastric metastasis in patients with ovarian cancer.

A 65-year-old man, known case of coronary artery disease on dual antiplatelet therapy, presented in emergency with two episodes of sudden onset haematemesis. There was no history of melena, altered bowel habits, flank pain, jaundice, generalised lymphadenopathy or bleeding tendencies in the past. On

Historically, gastric metastasis from renal cell cancer (RCC) has been extremely rare. As RCC is now being treated with various agents of targeted therapy, however, the rate of unusual visceral metastases might increase as outcomes improve and follow-up periods grow longer. Here we present a valuable case of gastric metastasis from RCC detected in a routine CT scan during sequential targeted therapy. A 73-year-old man was referred to our hospital, presenting with left renal cell cancer with multiple lung metastases at stage cT1bN0M1. He received first-line targeted therapy consisting of sunitinib and subsequently underwent left radical nephrectomy. He then underwent sequential therapy consisting of interferon-alpha, sunitinib, everolimus, and axitinib for multiple lung metastases. Five years after nephrectomy, a follow-up computed tomography scan revealed a 2.2 × 1.6 cm mass in the stomach without any symptoms. Gastrointestinal endoscopy disclosed a polypoid lesion at the gastric fundus. Endoscopic submucosal resection was performed. Microscopic diagnosis revealed gastric metastasis from RCC. As various new therapeutic agents increase survival periods for metastatic RCC patients in this era of targeted therapy, clinicians must watch for metastasis in the stomach, though this was formerly a rare event.

Gastric metastasis from ovarian cancer is exceptionally rare and generally occurs in advanced stages. A 71-year-old woman presented with a solitary gastric submucosal mass 8 years after the diagnosis of a stage IA ovarian serous adenocarcinoma. Endoscopy showed a tumor covered with normal gastric mucosa. Initially, a gastrointestinal stromal tumor was suspected, but biopsy revealed a histology of invasive micropapillary carcinoma, similar to the histological findings of the previously resected ovarian tumor. Clinicians should consider that in patients with a submucosal tumor and a history of ovarian cancer, gastric lesions may be secondary metastases from ovarian cancer.

Breast cancer is the mostly seen malignancy of women. Breast cancer causes lung, bone, liver and brain metastasis. On the other hand, gastric metastasis of breast cancer is a rarely seen metastasis. For this reason, it may be misdiagnosed or diagnosed after its morbid or mortal complications occurred. This may also result as a delay of breast cancers primary treatment. If occurred the best tool is immunohistochemical panels especially gross cystic disease fluid protein 15 (GCDFP-15) for exact diagnosis. In our case, a gastric metastasis of breast cancer is presented which was admitted with the acute abdominal findings caused by its result as gastric perforation and diagnosed by GCDFP-15 immunohistochemical panel.

Rationale: Gastric metastasis from invasive lobular breast cancer is relatively rare, commonly presented among multiple metastases, several years after primary diagnosis of breast cancer. Importantly, gastric cancer that is synchronously presented with lobular breast cancer can be misdiagnosed as primary gastric cancer; therefore, accurate differential diagnosis is required. Patient concerns: A 39-year-old woman was visited to our hospital because of right breast mass and progressive dyspepsia. Diagnoses: Invasive lobular carcinoma of breast was diagnosed on core needle biopsy. Gastroscopy revealed a diffuse scirrhous mass at the prepyloric antrum and diagnosed as poorly differentiated adenocarcinoma on biopsy. Synchronous double primary breast and gastric cancers were considered. Detailed pathological analysis focused on immunohistochemical studies of selected antibodies, including those of estrogen receptors, gross cystic disease fluid protein-15, and caudal-type homeobox transcription factor 2, were studied. As a result, gastric lesion was diagnosed as metastatic gastric cancer originating from breast. Interventions: Right breast conserving surgery was performed, and duodenal stent was inserted under endoscopic guidance to relieve the patient's symptoms. Systemic chemotherapy with combined administration of paclitaxel and trastuzumab was initiated. Outcomes: Forty-one months after the diagnosis, the patient is still undergoing the same therapy. No recurrent lesion has been identified in the breast and evidence of a partial remission of gastric wall thickening has been observed on follow-up studies without new metastatic lesions. Lessons: Clinical suspicion, repeat endoscopic biopsy, and detailed histological analysis, including immunohistochemistry, are necessary for diagnosis of metastatic gastric cancer from the breast.

Gastrointestinal metastases from breast cancer are rare and generally occur several years after the diagnosis of the primary lesion. The diagnosis of gastric metastasis as the initial presentation of breast cancer is even rarer and can potentially mimic gastric carcinoma. We report the case of a 66-year-old female patient submitted to a total gastrectomy because of the histological diagnosis of undifferentiated gastric carcinoma. During the surgical procedure, biopsies of the peritoneum and the liver were performed, which were consistent with metastatic breast invasive lobular carcinoma (ILC). The primary lesion of the breast was detected during the post-operative period, when a 4-cm-long lesion was detected on physical examination and mammography. The revision of the gastric biopsy confirmed the diagnosis of ILC. The authors call attention to the rarity of gastrointestinal metastases as the initial presentation of breast ILC.

Peritoneal and gastrointestinal metastasis from breast cancer is very rare. We report here a rare case of metastatic peritoneal and gastric cancer from breast lobular carcinoma after modified radical mastectomy. A 65-year old woman presented with anorexia, nausea, vomiting and dyspepsia for several weeks at 44 months after surgery. Radiologic study showed peritoneal metastasis, and surgical histopathology reported peritoneal and omental metastatic carcinoma. Esophagogastroduodenoscopic (EGD) biopsy also confirmed metastatic carcinoma originated from breast primary.

Primary lung cancer is the fourth most frequently diagnosed cancer, but gastric metastasis from lung cancer is extremely rare. Little is known about its clinicopathological features, prognosis and optimal treatment strategy. The present study reports a case of primary lung cancer that metastasized to the stomach and to the best of our knowledge, is the first to identify discordance in epidermal growth factor receptor (EGFR) mutation status between the primary tumor and gastric metastasis. The study also systematically searched the Medline database for similar cases to provide a literature review. Data concerning the clinicopathological features, treatment strategies and outcomes were extracted and analyzed. In total, 22 eligible cases were identified from 16 studies. The average age at presentation was 67.3 years and there was a male predominance of 90.9%. Epigastric pain (45.5%) was the most common chief complaint, followed by melena (22.7%), nausea/vomiting (13.6%) and hematemesis (9.1%). Three patients were asymptomatic. Five patients sought the initial consultation for gastrointestinal symptoms. The median time between the primary lung cancer diagnosis and the confirmation of gastric metastasis was five months. Endoscopically, gastric lesions were described as polypoid masses or volcano-like ulcers, mostly involving the gastric corpus, which were identified in 62.5% of the 16 cases in which information regarding the site of metastasis was available. Gastric metastases were reported from adenocarcinoma, squamous cell carcinoma, small cell lung cancer and pleomorphic carcinoma of the lung. The median survival following comprehensive treatment strategies was four months, and the one-year post-metastasis survival rate was 35.3%. In conclusion, although primary lung cancer metastasis to the stomach is rare, clinicians should be aware of the possibility of its occurrence. Comprehensive and personalized treatment may be beneficial to patients. EGFR tyrosine-kinase inhibitor therapy may be the treatment of choice for non-small cell lung carcinoma patients harboring an activating EGFR mutation in the metastatic lesion.

Gastric metastasis is rare but it can be the initial symptom of cancer. The second leading cause of this type of metastasis is breast cancer. A lack of clinical signs and nonspecific side effects of the treatment of primary tumors can lead to the misdiagnosis of metastatic gastric cancer. Upper gastrointestinal endoscopy with biopsy and immunohistochemistry should be used for diagnosis. Treatment is palliative; it includes chemo, endocrine, and radiation therapies. Four patients with breast cancer and gastric metastasis were identified. All the patients tested positive for estrogen and progesterone receptors, and received chemotherapy and hormone therapy. One patient underwent surgery and two received radiation therapy. Patients with breast cancer and gastrointestinal symptoms should be investigated for gastric metastasis, given its morbidity and negative impact on quality of life.

We describe an uncommon case of a patient with a metastatic adenocarcinoma of ovarian origin presented as a gastric subepithelial tumor (SET) and that was diagnosed by endoscopic ultrasound fine-needle biopsy (EUS-FNB). Malignant gastric lesions are rarely metastatic and the primary tumor is mainly breast, lung, esophageal cancer or cutaneous melanoma. Gastric metastasis from ovarian cancer is unusual, presenting synchronously with the primary tumor but also several years later than the initial diagnosis. From an endoscopic point of view, gastric metastasis does not present specific features. They may mimic both a primary gastric tumor or, less frequently, an SET. This case demonstrates the importance of EUS-FNB in distinguishing SETs and how this may alter treatment and prognosis.

A 59-year-old Japanese man was admitted to our hospital because of a 1-month history of dysphagia. Endoscopic examination revealed a superficial esophageal squamous cell carcinoma and a giant gastric tumor. Computed tomography showed that the gastric tumor was directly invading the liver and pancreas. Because of the risk of the gastric tumor causing obstruction and bleeding, we performed a subtotal esophagectomy, proximal gastrectomy, left lateral segmentectomy of liver, and pancreatosplenectomy with gastric tube reconstruction. Final pathological findings were superficial esophageal carcinoma penetrating the muscularis mucosae with an intramural gastric metastasis directly invading the liver and pancreas. The patient received postoperative adjuvant chemotherapy, yet died 8 months postoperatively of complications of local recurrence. Early-stage esophageal carcinoma with intramural gastric metastasis is very rare. To our knowledge, this is the first case of mucosal esophageal carcinoma with intramural gastric metastasis directly invading other organs.

Metastatic melanoma from an unknown primary (MUP) is rare; its occurrence in the gastrointestinal tract is of exceedingly low prevalence. We report a case of a 73-year-old man with metastatic malignant melanoma to the colon from an unknown primary. The rarity of MUP and importance of screening for gastrointestinal metastasis in patients with malignant melanoma are discussed along with the role of surgical resection in improving prognosis and overall survival.

Background: Non-small cell adenocarcinoma is a frequent tumour entity with a high mortality. Insight into molecular mechanisms has led to the development of promising therapeutic options, which improve the prognosis of affected patients. There are only a few reports on molecular tumour subtypes and clinical presentation of the disease. We present the case of a patient with anaplastic lymphoma kinase (ALK)-positive adenocarcinoma of the lung with an unusual metastatic pattern. Conclusion: The metastatic pattern of non-small cell lung cancer with ALK translocation may be different from other lung cancers. An uncommon clinical presentation may sensitize treating physicians to perform corresponding molecular testing in order to offer the best treatment options.

SUMMARY We report a case of a never-smoker male originally diagnosed with stage IIIb non-small-cell lung cancer that then presented with metastatic disease (EGFR/KRAS wild-type and ALK-positive) confined to the omentum 6 years later. Early metastasis to a variety of internal organs is common in the course of disease. Gastrointestinal metastasis of non-small-cell lung cancer is relatively rare and is typically found in the gastric or small bowel regions. Metastasis to the omentum is commonly seen with certain gynecologic cancer, but has not yet been well documented in pulmonary malignancies. Increasing use of molecular markers has altered the diagnosis, management and possible long-term prognosis of various subcategories of lung cancer. ALK-associated mutations have been found in a small minority of patients and its presence requires the use of novel therapeutics and, possibly, more prolonged surveillance for late metastasis.

Lung cancer is the most frequent cause of cancer death in the world. Although about 50% of lung cancers have distant metastases at the time of diagnosis, gastrointestinal metastasis has rarely been described. The most common metastatic site is the small bowel, whereas, colonic metastases are very rare. This report presents a clinical case of a 68-year-old male with a previous diagnosis of non-microcytic lung carcinoma (T4, N2, M1), stage IV, who presented rectorrhagia at the emergency. Colonoscopy showed many ulcerated tumors along the colon and histology proved that these lesions were metastases of primitive lung carcinoma. Gut metastasis from the lung is uncommon but we have to be aware of it in patients who present gastrointestinal symptoms.

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Lung cancer is one of the leading causes of cancer-related mortality worldwide. Gastrointestinal metastasis from primary lung cancer is rare. Only a few reports have been published and the majority of described metastatic sites involved the small intestine. In the present study, we report the first case of primary lung adenocarcinoma with both gastric and colonic metastases. We also review the published literature of primary lung cancer with gastrointestinal metastasis.

Background. Evidence of gastric metastasis from lung cancer is rarely observed at initial diagnosis. Case 1. A 74-year-old woman with anorexia was referred to our hospital due to upper lobe atelectasis of the left lung noted on a chest X-ray film. Bronchoscopic examination revealed obstruction of the left upper bronchus by a tumor. A biopsy specimen from the mass demonstrated small cell cancer. Upper gastrointestinal endoscopy showed an elevated lesion forming a central depression ("bull's eye") in the antrum. Immunohistochemical examination confirmed metastasis from small cell lung cancer. Despite chemotherapy with carboplatin and etoposide, the patient did not respond to treatment and died of lung cancer 3 months after admission. Case 2. A 76-year-old man with a chief complaint of epigastralgia was given a diagnosis of small cell lung cancer of the right lower lobe. Endoscopic examination revealed an elevated lesion forming a "bull's eye" in the gastric corpus. A biopsy specimen from the tumor demonstrated metastasis from small cell lung cancer, and he died of lung cancer 1 month after diagnosis. Conclusion. Opportunities to identify gastric metastasis from lung cancer are likely to increase with the increasing incidence of lung cancer. On diagnosis of gastric metastasis, upper gastrointestinal endoscopy is useful for proper staging and treatment. The possibility of gastric metastasis should be considered when patients complain of anorexia or epigastralgia at initial diagnosis. © 2012 The Japan Lung Cancer Society.

Background: Merkel cell carcinoma (MCC) is a rare, highly aggressive cutaneous neoplasm, with a propensity for recurrence and metastasis. Very few cases of metastases to the gastrointestinal tract have been reported in the medical literature. Objectives: The aim of this study was to report a case of MCC metastasizing to the stomach, its clinical presentation, and its management. Methods: A PubMed search was made using the following search terms: “Merkel cell carcinoma,” “gastric,” and “metastasis.” Results: The investigators report a case of MCC metastatic to the stomach presenting with melena, syncope, early satiety, increasing fatigue, and unintentional weight loss. The other known cases of gastrointestinal metastasis of MCC are summarized and critically reviewed. Conclusions: Although MCC spreading to the stomach is exceedingly rare, because of MCC’s high recurrence rate and metastatic potential, it should be considered in patients with histories of MCC presenting with recent weight loss, early satiety, and gastrointestinal bleeding.

Gastric metastasis from lung cancer is rare. We here present the case of a 59-year-old man with lung adenocarcinoma where isolated gastric metastases were discovered on staging F-FDG PET-CT, confirmed with endoscopy and biopsy.