Early gastric cancer giving rise to bone and brain metastases--a review of the Japanese literature.

A forty-year-old female consulted a hospital complaining of epigastralgia. She underwent endoscopy, which showed irregular shaped ulceration with fold convergence; the biopsy specimen revealed poorly differentiated adenocarcinoma. She underwent subtotal gastrectomy and lymph node dissection. Histological findings revealed the signet-ring-cell cancer confined to the mucosa and no lymph node metastasis. The serum carcinoembryonic antigen was elevated 2 years and 11 months after operation. Bone scintigraphy demonstrated multiple accumulation and bone biopsy of the sacrum revealed the metastatic gastric cancer. She underwent chemotherapy and radiation, however, later complained of nausea, vomiting, and diminished visual acuity. Brain computed tomography revealed multiple brain metastasis. She died 3 years and 6 months after her operation. We reviewed the 39 reported cases of early gastric cancer with bone metastasis in Japan, which suggests that signet-ring-cell carcinoma and poorly differentiated carcinoma have a possibility of bone metastasis even though the early gastric cancer is confined to the mucosa.