[A Case of Metastases to the Bone, Skin, and Ovary from Gastric Cancer Occurring More Than Eight Years after Distal Gastrectomy].

We report a 72-year-old woman with rare metastases of gastric cancer to the bone, skin, and ovary occurring more than 8 years after distal gastrectomy, which were subsequently effectively controlled. Histopathological diagnosis revealed signetring cell carcinoma, and the comprehensive findings were pT4a, pN3, ly2, v0, and Stage III c. The adjuvant chemotherapy of S- 1 plus cisplatin(CDDP)was switched to S-1monotherapy for 4 years and then to tegafur/uracil(UFT)for an additional year. Eight years after the operation, I-CTP and alkaline phosphatase(ALP)levels were elevated, and bone scintigraphy revealed bone metastasis. The patient's ALP levels, which had increased to 6,617 U/L, remarkably decreased to 359 U/L 17 months after treatment with zoledronic acid. About 9 years after the operation, a 2cm subcutaneous node was seen on the patient's scalp, and a biopsy was performed. Histologically, the node was confirmed as a signet-ring cell carcinoma. S-1 therapy was initiated, and the node disappeared within 8 months. About 10 years after the gastrectomy, abdominal computed tomography( CT)scans indicated a tumor sized 11×10 cm in the pelvis, and a biopsy was performed. Histologically, the tumor was a signet-ring cell carcinoma appearing as an ovarian metastasis of gastric cancer. Ovariectomy was performed. Peritoneal dissemination was not detected. The patient was treated with S-1 plus oxaliplatin and zoledronic acid, and continues to remain in good condition 9 months after the ovariectomy.