Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2015; 3(6): 533-537
Published online Jun 16, 2015. doi: 10.12998/wjcc.v3.i6.533
Intestinal type gastric adenocarcinoma with unusual synchronous metastases to the colorectum and bladder
Isaac Seow-En, Francis Seow-Choen
Isaac Seow-En, Department of General Surgery, Singapore General Hospital, Singapore 169608, Singapore
Francis Seow-Choen, Seow-Choen Colorectal Centre Pte Ltd, Singapore 238859, Singapore
Author contributions: Seow-En I performed the literature review wrote the draft manuscript; Seow-Choen F performed the surgery and critically revised the manuscript; all authors read and approved the final manuscript.
Ethics approval: Institutional review board waiver was accorded as per institution regulation on the basis of anonymity and patient’s consent for publication.
Informed consent: The patient provided written consent prior to study enrolment.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Isaac Seow-En, MBBS, Resident, Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Telephone: +65-96423931
Received: December 17, 2014
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.

Keywords: Gastric adenocarcinoma, Intestinal-type, Metastasis, Colorectum, Bladder

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.