Intestinal type gastric adenocarcinoma with unusual synchronous metastases to the colorectum and bladder

Figure 1 Laparoscopy examination. A: Laparoscopic view of the pelvic organs; Bladder (white arrow) and rectum (black arrow) look grossly normal. Moderate amount of greenish ascites seen; B: Transverse colon serosa normal looking except for thickened appendices epiploicae (white arrow); C: Gastric tumour seen at lesser curve on EGD; D: Extensive circumferential rectal mucosal tumour with luminal narrowing.

Figure 2 Gastric biopsy showing intestinal type gastric adenocarcinoma.

Figure 3 CK7 with strong cytoplasmic positivity (A) and CDX2 with diffuse and strong nuclear positivity (B).

Figure 4 CK20 negative (A) and few signet ring cells seen with mucicarmine staining (B).