Metastases from Gastric Carcinoma to Colon in the Form of Multiple Flat Elevated Lesions: A Case Report

胃癌轉移至大腸以多發性扁平隆起病灶來表現－病例報告

李熹昌(Hsi-Chang Lee) ； 楊旻達(Min-Ta Yang) ； 林光洋(Kuang-Yang Lin) ； 杜興洋(Hsing-Yang Tu) ； 張廷安(Ting-An Zhang) ； 陳寶輝(Pao-Huei Chen)

《The Kaohsiung Journal of Medical Sciences》 20卷11期 (2004/11) Pp. 552-557

摘要

胃癌是全世界常見的癌症。胃癌末期常常轉移至身體其他器官，然而轉移至大腸卻很少發生。我們報導一例以腹脹及體重減輕為主要的胃癌病例，此病人血清CEA值上升，上消化道內視鏡檢查顯示胃體部充滿巨大皺壁並，病理切片顯示為signet ring狀分化不良性胃腺癌，全大腸鏡檢發現在橫結腸、降結腸及乙狀結腸散佈著5-6個不連續扁平隆起狀病灶，病灶的大小約為3-5公厘頂端有糜爛且界線明顯，病灶切除病理報告為分化不良性胃腺癌，類似胃的病理切片報告。總結此病例為signet ring狀分化不良性胃腺癌併罕見扁平隆起狀病灶的大腸轉移　之後併發快速淋巴轉移至胸腔及腹腔，病程只有46天即去世。

關鍵字

胃癌 ； 大腸轉移 ； 扁平隆起病灶

並列摘要

Gastric carcinoma is a common malignancy worldwide. Advanced stages of the disease may result in metastases to many other organs of the body. However, colonic metastases are rare. We report a case of gastric carcinoma with symptoms of abdominal fullness and weight loss. The serum carcinoembryonic antigen level was elevated. Esophagogastroduodenoscopy revealed giant folds occupying the whole gastric body and poor expansion of the stomach. Histologic examination of biopsy specimens from the giant fold demonstrated poorly differentiated adenocarcinoma with signet ring-cell differentiation, Total colonoscopy revealed five or six discrete flat elevated lesions in the distal transverse, descending, and sigmoid colons. These lesions were characterized by a clear margin of 3-5mm in diameter and erosions on the tips. Polypectomy specimens demonstrated signet ring-cell carcinoma, which was histologically similar to the specimens taken from the gastric lesion. We conclude that this was a rare case in which gastric signet ring-cell carcinoma had metastasized to the colon in the form of flat elevated lesions, combined with rapid and wide lymphatic spread to the thorax and abdomen in a clinical course as short as 46 days.

並列關鍵字

gastric carcinoma ； colonic metastases ； flat elevated lesion