Edema of limbs as the primary symptom of gastric signet-ring cell carcinoma: A case report and literature review

Table 1 Characteristics of laboratory examinations

Parameter	Initial visit	3 mo	12 mo	Reference value range
Full blood count
White cell count as × 109/L	6.4	7.55	3.58	(3.5-9.5)
Neutrophils as × 109/L	4.51	5.56	2.25	(1.8-6.3)
Lymphocytes as × 109/L	1.3	1.32	0.68	(1.1-3.2)
Monocytes as × 109/L	0.36	0.5	0.23	(0.1-0.6)
Platelets as × 109/L	218	223	208	(125-350)
Hemoglobin in g/L	144	136	157	(130-175)
Tumor markers
Carbohydrate antigen 724 in U/mL	16.41	15.51	15.67	(< 6.9)
Carbohydrate antigen 199 in U/mL	15.88	16.84	4.43	(≤ 34)
Carcinoembryonic antigen in ng/mL)	2.81	2.86	0.78	(≤ 5)
Blood biochemical indicators
Alanine aminotransferase in U/L	16	11	14	(≤ 41)
Aspartate aminotransferase in U/L	13	13	15	(≤ 41)
Globulin in g/L	28.9	25.5	19	(64-83)
Albumin in g/L	38.2	32.2	25	(35-52)
Creatine kinase in U/L	93	56	24	(≤ 190)
Lactic dehydrogenase in U/L	163	156	202	(135-225)
Urea nitrogen in mmol/L	8.97	12.54	12.83	(3.1-8.0)
Creatinine in μmol/L	126	130	152	(59-104)
Estimated glomerular filtration rate in mL/min/1.73 m2	55	52.9	49.5	(> 90)
Random blood glucose in mmol/L	6.22	5.39	6.12	(< 11.1)
Serum potassium in mmol/L	4.2	3.88	3.89	(3.5-5.1)
Serum sodium in mmol/L	141.5	141	142	(136-145)
Cardiac troponin T in pg/mL	2.2	2.5	2.7	(≤ 34.2)
N terminal pro B type natriuretic peptide in pg/mL	53	45	59	(< 161)
Fibrinogen in g/L	4.31	5.03	5.88	(2-4)
D-Dimer in μg/mL FEU	1.36	1.05	7.19	(< 0.5)
Other indicators
Antinuclear antibodies	1:100	1:100	Not available	(negative)
Immunoglobulin IgG in g/L	9.31	8.57	9.27	(7-16)
Complement C3 in g/L	1.46	1.32	1.39	(0.8-1.8)
Complement C4 in g/L	0.67	0.39	0.51	(0.1-0.4)
Erythrocyte sedimentation rate in mm/h	20	21	25	(0-15)
High sensitivity C-reactive protein in mg/L	5.52	6.43	6.83	(0-5)
Interleukin 6 in pg/mL	2.72	3.56	2.98	(0.1-2.9)
Tumor necrosis factor α in pg/mL	2.07	2.97	3.12	(0.1-23)
T lymphocyte (CD3 + CD19 -) as /μL	830	977	780	(955-2860)
B lymphocyte (CD3 + CD19 -), as /μL	62	84	52	(90-560)
Proteinuria	negative	negative	negative	(negative)
Antineutrophil cytoplasmic antibody	negative	negative	negative	(negative)
Procalcitonin	< 0.05	< 0.05	< 0.05	(< 0.05)

Table 2 Gastric signet ring cell adenocarcinoma

Patients	Sex/age	Sites of skin involvement	Initial present symptoms	Stage	Follow-up	Management	Ref.
1	Male/67	Nodular lesions on his eyelid, cheeks, scalp, and back	Weight loss of 8 kg within 1 mo	Not available	DOD 3 mo after skin	XELOX chemotherapy (oxaliplatin and capecitabine)	[23]
2	Male/69	On forehead, back, neck, and arms	Dysphagia from eating and multiple cutaneous nodules	Not available	DOD 1 mo after skin	Surgery	[24]
3	Female/53	On abdomen and thighs	Livedo reticularis	Not available	DOD 7 mo after skin	Chemoradiation	[25]
4	Female/72	Skin infiltration in the lower limbs, abdomen, and root of the upper limbs	Lymphangitis	Stage IIIa	DOD 5 mo after skin	Adjuvant chemotherapy with capecitabine + oxaliplatin	[26]
5	Female/75	On the abdomen	Indurated scarlike lesions on the epigastric area	Stage IIIa (T4aN1M0)	DOD 3 mo after skin	Chemotherapy (5-fluorouracil, infusional folinic acid, and oxaliplatin)	[27]
6	Female/57	On the abdomen	With growing lesions on skin	Stage IIIa (T3N2M0)	Not available	Adjuvant chemotherapy [infusional folinic acid + 5-fluorouracil] and radiotherapy, a second round of chemotherapy	[20]
7	Female/45	On head and the back	The cutaneous metastases disappeared		Survival	Chemotherapy with S-1 (Tegafur) plus cisplatin	[28]
8	Male/52	Armpits, axillae, groin, and neck folds	Progressive dermal, mucosal, and perianal lesions, weight loss	T3N2M1	Not available	N/A	[18]
9	Male/21	Cutaneous nodule on his chest	Cutaneous nodule	Stage IV	Survival	Chemotherapy with oxaliplatin (day 1) and S-1	[29]
10	Male/85	A lesion of the right occipital scalp	Abdominal pain, malaise	T4N1M0	DOD 5 mo after skin	Not available	[30]
11	Male/35	Cutaneous nodules on the upper chest, abdomen and left scapular region	Without any local or general clinical symptoms	Not available	Not available	Not available	[15]
12	Male/76	Skin ulcer on right hypochondrium	Hematemesis, weight loss and loss of appetite	T4N2M0	DOD 1 mo after skin	Chemotherapy with irinotecan and oxaliplatin	[16]
13	Female/50	Large erythematous plaque on the left side of the neck; and an erythematous lesion in the perineal region	Bowel habit and weight loss	Not available	DOD 0.5 mo after skin	Not available	[31]
14	Male/59	Painless nodule of the left flank	Painless nodule of the left flank	Not available	DOD 0.5 mo after skin	Metastatic infiltration of a 32-yr-old surgical scar	[32]
15	Male/50	The umbilical area	With a single asymptomatic skin lesion	Not available	Not available	Not available	[19]
16	Male/69	Asymptomatic indurated scar-like lesion	Asymptomatic indurated scar-like lesion	Stage IV	DOD 10 mo after skin	Chemotherapy with cisplatin, Taxotere, and xeloda	[33]
17	Female/71	Limited cyan erythema on the right side of the middle and lower abdomen	Abdominal skin	Not available	DOD 12 mo after skin	Chemotherapy (unknown medication)	[34]
18	Male/48	Bracelet bracelet ("tripe palm"); and hyperkeratosis of fingers	Skin edema with pigmentation	Not available	DOD 36 mo after skin	Chemotherapy with cisplatin, 5-fluorouracil and folic acid	[35]
19	Male/44	Multiple cutaneous eruptions on face and neck	Vomiting and weight loss	Not available	N/A	Not available	[17]
20	Male/51	Abdominal and back	Without any symptom	Not available	DOD 2 mo after skin	Surgery	[36]
21	Male/67	Diffuse erythematous and warm induration over his right cheek and neck	Dyspepsia	Stage IV	DOD 0.75 mo after skin	Radiotherapy	[37]
22	Male/55	Lower part of face and neck	With multiple itchy nodules	Not available	DOD 7~8 mo after skin	Not available	[21]
23	Female/58	Right inguinal erythema with itching	With chylothorax	Not available	DOD 4 mo after skin	Not available	[38]
24	Male/44	On the face, trunk, and upper extremities	Multiple cutaneous nodules	Stage IV	Survival	Chemotherapy with an oxaliplatin-based regimen and denosumab	[39]
25	Male/68	Right chin region and on the left forehead	Erythematous skin lesion, nodular skin lesion	T4N0M0	Not available	Surgical treatment	[40]

DOD: Dead of disease; N/A: Not applicable.