Resection of skin metastases from gastric carcinoma with long-term follow-up: an unusual clinical presentation.

BACKGROUND: Skin metastases from gastric cancer are rare and generally occur at a very late stage in the course of the disease. CASE REPORT: A 60-year-old patient with localized adenocarcinoma of the cardia (stage II) was primarily treated with extended total gastrectomy with transhiatal resection of the distal esophagus. 6 isolated skin metastases occurred on the head and on the thigh 2 years later. These lesions where all surgically removed. Morphologically and according to an extensive immunohistochemical comparison the skin lesions and the primary tumor were identical. The patient presented with dysphagia more than 6 years after the primary diagnosis, and a local recurrence was diagnosed. Again a surgical procedure was chosen and a transthoracal esophagectomy with intrathoracic esophagojejunostomy was performed. This patient remains free of symptoms and is clinically in complete remission 7.5 years after the primary diagnosis.
CONCLUSION: We report a long-term disease-free survival of a patient with isolated cutaneous metastases of a gastric cancer. Usually the prognosis after occurrence of metastases to the skin is poor, but long-term survival after systemic therapy has been reported. This patient is clinically in remission more than 5 years after surgical resection of several cutaneous metastases and after successful resection of a local recurrence more than 1 year ago. One should be aware of such unusual clinical courses of a disease, and that the prognosis can deviate significantly from the average when the pattern of metastasis is unusual.