Early gastric cancer with suspected brain metastasis arising eight years after curative resection: a case report

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From: BMC Research Notes(Vol. 7, Issue 1)
Publisher: BioMed Central Ltd.
Document Type: Article
Length: 2,848 words
Lexile Measure: 1320L

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Author(s): Katsunobu Sakurai1 , Kazuya Muguruma1 , Akihiro Murata1 , Takahiro Toyokawa1 , Ryosuke Amano1 , Naoshi Kubo1 , Hiroaki Tanaka1 , Masakazu Yashiro1 , Kiyoshi Maeda1 , Masaichi Ohira1 and Kosei Hirakawa1


Gastric cancer is one of the most common gastrointestinal tumors in Japan. Outcomes for patients with early gastric cancer have improved thanks to advances in diagnosis and treatment. However, patients with unresectable or recurrent gastric cancer still experience poor outcomes. Recurrence of gastric cancer often appears in the form of peritoneal dissemination, and liver metastases, lymph node recurrence and bone metastases are often seen.

The frequency of brain metastasis from gastric cancer is less than 1% [1-3]. Almost all brain metastases from gastric cancer are seen in advanced-stage disease with concurrent metastasis to other organs. Brain metastasis after curative gastrectomy for early gastric cancer appears extremely rare, and to our knowledge, there is no report of brain metastasis arising 8 years after curative operation for early gastric cancer. Palliative care is often performed for the patient with brain metastasis according to the other metastasis as terminal stage. However aggressive treatment such is warranted for brain metastases because of the damage to neurological function and quality of life (QOL). The present report describes a case with brain metastases after curative resection for early gastric cancer.

Case presentation

A 78-year-old Japanese female had been diagnosed with gastric cancer 8 years earlier and underwent distal gastrectomy. The tumor size was 45 x 45 mm, and no lymph node metastases were noted. Histological type of the tumor was well-differentiated adenocarcinoma. Final pathological TNM classification was T1b(sm1)N0M0, and the clinical stage was IA according to the Union for International Cancer Control criteria. Postoperative course was uneventful. After discharge, the patient underwent biannual follow-up with blood tests and abdominal computed tomography (CT). She received no adjuvant chemotherapy. She was referred to our hospital complaining of dizziness and an inability to walk. Brain CT revealed a tumor (diameter, 2.5 cm) with ring enhancement in the cerebellum (Figure 1). Abdominal CT revealed multiple liver metastases. No ascites or peritoneal dissemination was seen. Magnetic resonance imaging of the head showed an enhanced tumor with central necrosis in the cerebellum and surrounding edematous changes on T1-enhanced imaging (fat suppression) (Figure 2). Endoscopy and colonoscopy did not detect any recurrent lesions in the gastrointestinal tract. Tumor marker levels were as follows: carcinoembryonic antigen, 6.0 ng/ml; and carbohydrate antigen 19-9, 19 U/ml. Microscopic examination of hematoxylin and eosin (HE)-stained percutaneous biopsy specimens of the liver metastasis revealed adenocarcinoma (Figure 3). Increased uptake was seen in the liver tumors and para-aortic lymph nodes (standardized uptake values: vermis cerebellum, 6.7; liver, 5.5-6.2; and para-aortic lymph node, 2.2) on 18 F-fluorodeoxyglucose-enhanced positron emission tomography. We thus diagnosed the liver and brain tumors as metastases derived from gastric cancer.

Figure 1:

Computed tomography (CT) of the brain shows a tumor (diameter, 2.5 cm) with ring enhancement in the cerebellum (arrow).

Radiotherapy for brain metastasis was performed in conjunction with corticosteroid...

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Gale Document Number: GALE|A540834042