AIM: To evaluate the clinical and endoscopic patterns in a large series of patients with metastatic tumors in the stomach. METHODS: A total of 64 patients with gastric metastases from solid malignant tumors were retrospectively examined between 1990 and 2005. The clinicopathological findings were reviewed along with tumor characteristics such as endoscopic pattern, location, size and origin of the primary sites. RESULTS: Common indications for endoscopy were anemia, bleeding and epigastric pain. Metastases presented as solitary (62.5%) or multiple (37.5%) tumors were mainly located in the middle or upper third of stomach. The main primary metastatic tumors were from breast and lung cancer and malignant melanoma. CONCLUSION: As the prognosis of cancer patients has been improving gradually, gastrointestinal (GI) metastases will be encountered more often. Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient's clinical history are useful for correct diagnosis of gastric metastases

DE PALMA, GIOVANNI DOMENICO

I. Simeoli

L. Iannone

M. Donisi

M. Rega

MASONE, STEFANIA

P. Addeo

PERSICO, GIOVANNI

V. Pilone

English

Archivio della ricerca - Università degli studi di Napoli Federico II

PO Box 2345, Beijing 100023, China                                                                                                              World J Gastroenterol  2006 December 7; 12(45): 7326-7328www.wjgnet.com                                                                                                                                          World Journal of Gastroenterology  ISSN 1007-9327wjg@wjgnet.com                                                                                                                                                                       © 2006 The WJG Press. All rights reserved.Metastatic tumors to the stomach: Clinical and endoscopicfeaturesGiovanni D De Palma, Stefania Masone, Maria Rega, Immacolata Simeoli, Mario Donisi, Pietro Addeo, Loredana Iannone, Vincenzo Pilone, Giovanni PersicoGiovanni D De Palma, Stefania Masone, Maria Rega, Immacolata Simeoli, Mario Donisi, Pietro Addeo, Loredana Iannone, Vincenzo Pilone, Giovanni Persico, Centro per l’Innovazione Tecnologica in Chirurgia (ITC)-Dipartimento di Chirurgia Generale, Oncologica e Tecnologie Avanzate. Università degli Studi di Napoli Federico II Facoltà di Medicina e Chirurgia, Napoli, ItalyCorrespondence to: Dott. Giovanni D De Palma, Centro per l’Innovazione Tecnologica in Chirurgia (ITC), Dipartimento di Chirurgia Generale, Oncologica e Tecnologie Avanzate. Università degli Studi di Napoli FedericoⅡ- Facoltà di Medicina e Chirurgia, Via Pansini, 5. Napoli 80131, Italy. giovanni.depalma@unina.itTelephone: +39-81-7462773  Fax: +39-81-7462773  Received: 2006-09-23             Accepted: 2006-10-27AbstractAIM: To evaluate the clinical and endoscopic patterns in a large series of patients with metastatic tumors in the stomach.METHODS: A tota l o f 64 pat ients wi th gast r i c metastases from solid malignant tumors were retros-pectively examined between 1990 and 2005. The clinicopathological findings were reviewed along with tumor characteristics such as endoscopic pattern, locations, size and origin of the primary sites. RESULTS: Common indications for endoscopy were anemia, bleeding and epigastric pain. Metastases presented as solitary (62.5%) or multiple (37.5%) and were mainly located in the middle or upper third of stomach. The main primary metastatic tumors were from breast and lung cancer and malignant melanoma. CONCLUSION: As the prognosis of cancer patients has been improving gradually, gastrointestinal (GI) metastases will be encountered more often. Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient’s clinical history are useful for correct diagnosis of gastric metastases.© 2006 The WJG Press. All rights reserved.Key words: Stomach; Metastatic tumors; Clinical fi ndings; Pathology; EndoscopyDe Palma GD, Masone S, Rega M, Simeoli I, Donisi M, Ad-deo P, Iannone L, Pilone V, Persico G. Metastatic tumors to the stomach: Clinical and endoscopic features. World J Gas-troenterol  2006; 12(45): 7326-7328 http://www.wjgnet.com/1007-9327/12/7326.aspINTRODUCTIONThe stomach is an unusual site for metastasis. There have been several published reports on metastatic lesions in the stomach. However, information on gastric duodenal metastases is generally limited to single case reports. The present study examined the clinopathological features in a large series of  patients with metastatic tumors in the stomach from distant sites.MATERIALS AND METHODSWe conducted a chart review of  patients with metastatic tumors of  the stomach detected endoscopically from January 1990 to December 2003. Patients with malignant lymphoma involving the stomach, or with direct invasion from neighboring organs, were excluded from this study. Analysis of  data included indication for endoscopy, endoscopic appearance, location, primary site and time interval between the diagnosis of  primary tumors and diagnosis of  metastatic lesions. RESULTSThe present study included 64 patients, 36 men and 28 women, with a mean age of  56 years (28-82 years). The common indications for endoscopy were anemia or bleeding (19 cases, 10 of  which had active bleeding), dyspepsia (15 cases) and epigastric pain (14 cases). Endoscopic fi ndings mainly included small nodules with or without central ulceration, polypoid mass and ulcers. The other findings included peptic ulcer scar and small black spots, which were metastatic tumors from malignant melanoma. Solitary metastases (40 cases, 62.5%) were more common than multiple metastases (24 cases, 37.5%). The solitary lesions were mainly located in the middle third (43%) or the upper third (45%) of  the stomach, and the proportion of  solitary lesions was similar to that of  multiple lesions. Forty percent of  the solitary lesions and  RAPID COMMUNICATIONwww.wjgnet.comDe Palma GD et al . Metastatic tumors to the stomach                                                                 7327www.wjgnet.com35% of  the multiple lesions were located on the greater curvature (Table 1).The diagnosis of  metastatic tumors was confirmed pathologically by endoscopic biopsies in 59 out of  64 cases (92.2%). The remaining 5 cases were diagnosed during surgery for uncontrollable bleeding from the tumor. The primary sites of  metastases are shown in Table 2.The average time interval between the diagnosis of  primary tumors and the diagnosis of  metastatic lesions was 25.7 mo (1-40 mo), and varied the site of  primary tumor (Table 3).DISCUSSION The stomach is an unusual site for metastasis[1-8]. As the prognosis of  cancer patients has been improving gradually, gastric metastases are encountered more frequently. In this series, lung, breast, and esophagus were the common primary metastatic sites, and malignant melanoma was associated with the highest rate of  metastases. More than half  of  the metastatic tumors were found within a year of  the diagnosis of  a primary tumor. In particular, most of  the gastric metastases from esophageal and lung cancer were detected within a year, since these cancers progress rapidly. On the other hand, breast cancer extended slowly, and it was sometimes more than three years before gastric metastases were diagnosed after the initial diagnosis of  the primary tumor. It was noteworthy that metastatic tumors were detected before diagnosis of  the primary tumors in 2 patients[8,9]. Symptoms of  metastatic tumors including pain, nausea, vomiting, and signs of  bleeding are nonspecifi c[4-9]. Endoscopy may be useful in the diagnosis and local treatment of  gastric metastases, such us endotherapy that was performed successfully in 5 out of  10 patients with active gastrointestinal (GI) bleeding (endoscopic clipping in 4 cases and adrenaline injection in 1 case). In our series, more frequent endoscopic patterns included multiple nodules, bull’s eye, extrinsic mass lesions, ulceration and polypoid tumor mass as previously reported[4-8,10-13].Solitary metastases were more common than multiple metastases. The solitary lesions were mainly located in the middle third (40%) or the upper third (40%) of  the stomach, and the proportion of  the solitary lesions was similar to that of  the multiple lesions. Forty percent of  the solitary lesions and 35% of  the multiple lesions were located on the greater curvature. About 90% of  the metastatic lesions could be confirmed histologically by endoscopic biopsies. Tumor-negative biopsies may be mainly due to extrinsic mass rather than due to sampling error. It should be emphasized that the endoscopist should provide the pathologist with suffi cient information about the patient’s history to allow an accurate pathological diagnosis.In conclusion, as the prognosis of  cancer patients has been improving gradually, GI metastases will be encountered more often.  Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient’s clinical history is useful for the correct diagnosis of  gastric metastasis.Table 1  Endoscopic appearance and location of metastatic lesions, n  (%)Small nodules 28 (43.7)Polypoid mass 18 (28.1)Ulcers   8 (12.5)Small black spots   6 (9.3)Peptic ulcer scar   4 (6.2)Lower third   8 (12.5)Middle third 27 (42.2)Upper third 29 (45.3)Solitary 40 (62.5)Multiple 24 (37.5)      Table 2  Site of primary tumor, n  (%)Breast 21 (32.8)Lung 16 (25.0)Malignant melanoma 14 (21.9)Head/Neck   4 (6.2)Uterus   4 (6.2)Colorectum   3 (4.7)Kidney   2 (3.1)Soft Tissue   1 (1.5)Table 3  Time interval between the diagnosis of primary tumors and diagnosis of metastatic lesionsTime (yr)    Patients               Primary Site      n  (%)           Lung         Breast        Melanoma  Other-1   2 (3.1)   1   11-2 33 (51.5) 11   9   7                     62-3 19 (29.6)   3   8   4   4> 3 10 (15.6)   1   4   3   2Total 64 (100) 16 21 14 13COMMENT 1. BackgroundsThe stomach is an unusual site for metastasis. There have been several published reports on metastatic lesion in the stomach and information on gastric duodenal metastases is generally limited to single case reports. The present study examined the endoscopic and clinopathological features in a large series of  patients with metastatic tumors to the stomach.2. Research frontiersAs the prognosis for cancer patients has been improving gradually, GI metastases will be encountered more often.  3. Innovations and breakthroughsMetastasis to stomach is rare, hence no large series has been published so far. The current study is an improve-ment in terms of  numbers of  cases. It reemphasises the same results which have been published earlier.REFERENCES1 Menuck LS, Amberg JR. Metastatic disease involving the stomach. Am J Dig Dis 1975; 20: 903-9132 Davis GH , Zollinger RW. Metastatic melanoma of the stomach. Am J Surg 1960; 99: 94-96 3 Oda I , Kondo H, Yamao T, Saito D, Ono H, Gotoda T, Yamaguchi H, Yoshida S, Shimoda T. Metastatic tumors to the stomach: analysis of 54 patients diagnosed at endoscopy and 347 autopsy cases. Endoscopy 2001; 33: 507-510 4 Taal BG, Westerman H, Boot H, Rankin EM. Clinical and endoscopic features of melanoma metastases in the upper GI tract. Gastrointest Endosc 1999; 50: 261-2635 Taal BG, Peterse H, Boot H. Clinical presentation, endoscopic features, and treatment of gastric metastases from breast carcinoma. Cancer 2000; 89: 2214-22216 Washington K, McDonagh D. Secondary tumors of the gastrointestinal tract: surgical pathologic findings and comparison with autopsy survey. Mod Pathol 1995; 8: 427-4337 Meyers MA, McSweeney J. Secondary neoplasms of the bowel. Radiology 1972; 105: 1-11 8 Tohfe M, Shami P, Aftimos G, Saade M. Gastrointestinal metastases from breast cancer: a case report. South Med J 2003; 96: 624-625 4. Applications Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient’s clinical history is useful for correct diagnosis of  gastric metastasis.5. TerminologyMetastatic tumors to the stomach.6. Peer reviewThe current paper gives retrospective analysis of  data on Metastatic tumors to stomach over a period of  15 years at author’s center. Metastasis to stomach is rare, hence no large series has been published so far. Oda et all have published a series of  54 cases of  metastatic tumors to stomach in 2001. The current study is slight improvement in terms of  numbers of  cases. Authors have reported in the current article that 19 cases underwent endoscopy due to bleeding and 5 cases were diagnosed with metastatic tumors at time of  surgery due to uncontrolled bleeding.S- Editor  Liu Y   L- Editor  Wang XL    E- Editor  Bai SH7328      ISSN 1007-9327      CN 14-1219/R     World J Gastroenterol       December 7, 2006    Volume 12    Number 45www.wjgnet.com

Metastatic tumors to the stomach: clinical and endoscopic features.

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Metastatic tumors to the stomach: clinical and endoscopic features.

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