1993 Volume 2 Issue 2 Pages 223-226,171
A patient with gastric carcinoma which recurred as a solitary colonic metastasis 10 years after gastrectomy is reported. The patient was a 52-year-old man who had undergone total gastrectomy and pancreatico-splenectomy (Appleby's procedure) for Type 5 gastric carcinoma. Histologic examination showed poorly differentiated adenocarcinoma invading the gastric wall to reach the serosal surface (se) with limited lymph node metastases (to n1 nodes). He remained well until 10 years after surgery, when he developed epigastric pain and abdominal distenton. Physical examination revealed a 10-cm-mass in the upper abdomen. Barium enema showed a circumferential stenosis at the midpoint of the transverse colon. Endoscopy showed the colonic mucosa was edematous and featured an irregular cobblestone pattern, that was suggestive of submucosal infiltration.
Under the working diagnosis of recurrent gastric cancer, transverse colectomy was performed. Histologic examination revealed poorly differentiated adenocarcinoma that was very similar to the gastric carcinoma resected 10 years earlier. Although the tumor was transmural, it was more extensive at the serosal surface and the mucosa was intact. Judging from the mode of extension, this case was diagnosed as solitary recurrence of gastric carcinoma in the transverse colon from a microscopic tumor focus.
