Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2022; 14(12): 2404-2414
Published online Dec 15, 2022. doi: 10.4251/wjgo.v14.i12.2404
Edema of limbs as the primary symptom of gastric signet-ring cell carcinoma: A case report and literature review
Bei Wang, Jing Chen, Ying Wang, Ling-Li Dong, Gui-Fen Shen
Bei Wang, Ling-Li Dong, Gui-Fen Shen, Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Jing Chen, Division of Cardiology, Department of Internal Medicine and Gene Therapy Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Ying Wang, Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Wang B wrote the manuscript; Chen J and Wang Y diagnosed and treated the patient; Dong LL collected associated references; Shen GF commented on the manuscript and all authors discussed the results, read and approved the manuscript.
Supported by The National Nature Science Foundation of China, No. 81900363.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gui-Fen Shen, MD, PhD, Doctor, Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan 430030, Hubei Province, China. guifenshen@126.com
Received: August 26, 2022
Peer-review started: August 26, 2022
First decision: September 8, 2022
Revised: September 17, 2022
Accepted: November 28, 2022
Article in press: November 28, 2022
Published online: December 15, 2022
Abstract
BACKGROUND

Metastatic skin cancers are relatively rare dermatological malignancies. They usually present as nodules, erythematous lesions, scar-like lesions or other lesion types. Signet-ring cell carcinoma (SRCC) is an uncommon histological type of gastric cancer that usually behaves aggressively and has a poor prognosis. Skin metastasis may be the first sign of clinically silent visceral cancer or recurrence of an internal malignancy.

CASE SUMMARY

Herein we report on the case of a 55-year-old man with edema of a lower extremity as the primary symptom which progressed from local to generalized pitting edema in the year following skin involvement. Pathological evidence from gastroscopic specimens and subcutaneous tissue biopsy showed typical signet-ring cells and gland-like structures. Consistently, immunohistochemical analysis revealed positive pan-cytokeratin expression in tumor cells. A diagnosis of gastric SRCC with skin metastasis was established. Moreover, lymphoscintigraphy showed an obvious accumulation of radiotracer on the anterior and posterior sides of the right leg which indicated lymphedema. We reviewed the relevant literature on subcutaneous metastases of gastric SRCC.

CONCLUSION

This rare case emphasizes the importance of physical examination as it may help elucidate the etiology of edema.

Keywords: Gastric cancer, Signet-ring cell carcinoma, Skin metastasis, Lymphedema, Prognosis, Case report

Core Tip: Metastatic skin cancers are relatively rare dermatological malignancies. They usually present as nodules, erythematous lesions, scar-like lesions or other lesion types. We report on a case of skin metastases from gastric signet-ring cell carcinoma in which lymphedema of the limbs presented as an initial symptom. This rare case emphasizes the importance of physical examination as it may help elucidate the etiology of edema.