Synchronous Rectal Metastases From Gastric Adenocarcinoma: A Case

Gastric carcinoma is a common malignancy disease in digestive system, and it take up the second cause of cancer death worldwide. Advanced stages of the disease may result in metastases to many other organs of the body. However, rectal metastases are rare. We report a case of gastric carcinoma with symptoms of abdominal pain, abdominal distension and melena. The serum carcinoembryonic antigen level was elevated significantly. Esophagogastroduodenoscopy revealed a giant ulcer in gastric antrum. Histologic examination of biopsy specimens from giant ulcer showed moderate-poorly differentiated adenocarcinoma. Total colonoscopy revealed a mass which Histological examination demonstrated adenocarcinoma, located between rectum and sigmoid colon. Abdominal computed tomography (CT) with intravenous contrast medium showed thickening of the gastric wall at the antrum, and thickening of the rectal wall between rectum and sigmoid colon. Total gastrectomy (D2 lymphadenectomy) was performed along with partial proctectomy (Dixon operation). Final pathology identified that the gastric lesion was moderate-poorly differentiated adenocarcinoma; the rectal leision was moderate-poorly differentiated adenocarcinoma. Immunohistochemical stains showed positivity for CDX2 and cytokeratin 7 (CK7), and negativity for cytokeratin 20 (CK20). Summary the case was moderate-poorly differentiated gastric adenocarcinoma synchronous metastases to rectum.