Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 4137-4143
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4137
Left armpit subcutaneous metastasis of gastric cancer: A case report
Feng-Jun He, Peng Zhang, Mo-Jin Wang, Yi Chen, Wen Zhuang
Feng-Jun He, Peng Zhang, Mo-Jin Wang, Yi Chen, Wen Zhuang, Department of Gastrointestinal Surgery, West China Hospital Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: He FJ reviewed the literature and contributed to manuscript drafting; Zhang P analyzed and interpreted the imaging findings; Zhuang W, Wang MJ, and Chen Y were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wen Zhuang, MD, PhD, Chief Physician, Department of Gastrointestinal Surgery, West China Hospital Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. zhuangwen1966@163.com
Telephone: +86-18980601497 Fax: +86-28-85422708
Received: September 26, 2019
Peer-review started: September 26, 2019
First decision: October 24, 2019
Revised: November 1, 2019
Accepted: November 14, 2019
Article in press: November 14, 2019
Published online: December 6, 2019
Processing time: 71 Days and 3.8 Hours
Abstract
BACKGROUND

Gastric cancer is the third most lethal malignant tumor worldwide. Metastasis has always been a major cause of poor prognosis. Epidemiological evidence shows that the most common sites for metastasis of gastric carcinoma are the liver (48%), peritoneum (32%), lung (15%), and bone (12%); however, subcutaneous metastasis is are and occurs in approximately 0.8% of cases. We report a rare case of armpit subcutaneous metastasis of gastric cancer. The best surgical window was missed, as a result of lacking attention of the mass.

CASE SUMMARY

A 69-year-old man who had previously undergone radical gastrectomy and received eight cycles of oral chemotherapy for gastric cancer showed a rapidly growing mass in his the left armpit; within just 3 mo, the mass grew to a size of 6.9 cm × 4.4 cm × 5.7 cm. Color Doppler ultrasonography and Positron emission tomography/computed tomography prompted the possibility of metastasis of the malignancy. Fine needle aspiration biopsy guided by color Doppler ultrasound showed the presence of cancer cells in the mass. Immunohistochemical examination showed CDX-2 (+), PCK (+), CK20 (+), CK7 (-), and TTF (-), which supported the metastasis of gastric cancer. Considering the risk of resection, the patient did not undergo surgical treatment.

CONCLUSION

The case indicates that unidentified subcutaneous masses in patients with a history of gastric cancer should be carefully evaluated.

Keywords: Stomach neoplasms; Neoplasm metastasis; Subcutaneous; Case report; Cancer therapy; Skin neoplasms

Core tip: Epidemiological evidence shows that the most common metastasis sites of gastric carcinoma are the liver (48%), peritoneum (32%), lung (15%), and bone (12%); however, subcutaneous metastasis is are and occurs in approximately 0.8% of cases. The recurrence and metastasis of malignant tumors still contribute to more than 90% of cancer mortalities. For the uncertainty of mechanism of metastasis and metastatic sites, and the limitations of monitoring methods, early detection of metastatic lesions of gastric cancer is difficult. This case demonstrates more sensitive and applicable monitoring methods and early attention may improve the early diagnosis rate.