Published online Jun 16, 2015. doi: 10.12998/wjcc.v3.i6.533
Peer-review started: December 18, 2014
First decision: January 22, 2015
Revised: February 14, 2015
Accepted: April 10, 2015
Article in press: April 14, 2015
Published online: June 16, 2015
A 75-year-old male presented with difficult defecation and increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tomography of the abdomen and pelvis showed extensive lymphadenopathy, a gastric mass and rectal as well as bladder wall thickening with bilateral ureterohydronephrosis. Normal looking serosal surfaces of the bladder and bowel were seen on laparoscopy and a defunctioning ileostomy was created. Gastroscopy revealed a malignant mass while cystoscopy and sigmoidscopy found extensive tumour growth lining the mucosal surfaces. Biopsies from all sites were compatible with intestinal type adenocarcinoma of gastric origin with few signet ring cells. Metabolic response to palliative chemotherapy was good and the patient’s symptoms have improved on follow-up four months post ileostomy. We discuss the immunohistochemical profile of the tumour and review the literature.
Core tip: Although exceedingly rare, metastases to the colorectum and bladder can occur with primary gastric adenocarcinoma. Unusual sites of spread are more often associated with diffuse type or signet ring cell gastric carcinoma but can occur with intestinal type as well. Site specific symptoms should alert the clinician to the possible locations of spread so as to allow prompt diagnosis. CK7 and CK20 profiles may help to establish the origin of the metastatic tumour if in doubt.