Gastric Adenocarcinoma Mucosecretor’s metastasis in retrosternal adipose tissue and sternal bone.

Abstract

Introduction: Gastric cancer 5-year survival rate is 10-30%. Occult micro metastasis lead to 80% of recurrences. Tumor markers, CT scan or echo endoscopy may help shorten the time to make diagnosis of the recurrences. We report a case of Gastric Adenocarcinoma Mucosecretor’s metastasis in retrosternal adipose tissue and sternal bone which might be the first published clinical case of this kind of metastasis.  Presentation of the case: A 63-year old patient with a subtotal gastrectomy for peptic ulcer years ago was diagnosed with poorly differentiated gastric adenocarcinoma. The patient was staged as cT4 because of an infiltration in the left hepatic lobe. After neoadjuvant chemotherapy, a total gastrectomy D2 with hepatic resection of the II liver segment was performed. Six months later in a control scan, a nodular image of 25 x 25 mm was located above transverse colon adjacent to the peritoneal wall whose biopsy was positive to poorly differentiated adenocarcinoma. Another R0 surgery was carried out, removing two implants: Only one was infiltrated by adenocarcinoma, which was considered to be a local regional recurrence. When tumor markers increased and the patient was affected with mechanical thoracic pain, a thoracic and abdominal scan showed disease progression, bilateral lung metastasis and a retrosternal mass which involved the anterior mediastinum with 22 mm bone inclusion. The biopsy showed infiltration by adenocarcinoma mucosecretor. Conclusion: Being the first case ever published is imperative to make the medical community aware of this extremely rare metastasis.