Metastases of a Gastric A d e n o c a r c i n o m a Presenting as C o l o n i c Polyposis Report of a Case Patrice Metayer, M.D.,* Michel Antonietti, M.D.,* Mohammed Oumrani, M.D.,* Jacques Hemet, M.D.,+ Franqoise Lemoine, M.D.,+ Jacques Basuyau+ From the * Service d'Endoscopie Digestive and +Service d'Anatomie Pathologique, H6pital Charles Nicolle, Rouen, France, and {Mbdecin gfn&raliste, Saint-Georges-du-Vievre, France The authors report a case of multiple colonic metastases of a gastric signet ring cell adenocarcinoma, presenting as colonic polyposis revealed by diarrhea, iron deficiency
The same pathologic abnormalities were found in all the polyps and around the gastric ulcer: infiltration of the mucosa and superficial part of the submucosa by a tumor composed of atypical epithelial clusters with the structure and differentiation of signet ring cell carcinomas (Figs. 1-3). The colonic polyps were therefore certainly metastatic from the gastric carcinoma. The patient died suddenly at home, in the last week of December 1989.
anemia, and left supraclavicular lymph node. [Key words: Colonic neoplasms; Colonic polyps; Stomach neoplasms; Digestive system neoplasms, secondary] Metayer P, Antonietti M, Oumrani M, Hemet J, Lemoine F, Basuyau J. Metastases of a gastric adenocarcinoma presenting as colonic polyposis: report of a case. Dis Colon Rectum 1991 ; 3 4 : 6 2 2 - 6 2 3 .
olonic metastases of gastric carcinomas are exceptional. 1-5 We report a case of diffuse colonic polypous metastases from a gastric adenocarcinoma.
C
DISCUSSION Among gastrointestinal metastases--colonic are rare, small intestine and gastric more frequent, and esophageal exceptional. 6 Colonic metastases generally originate from carcinomas of the breast, stomach, or skin (melanomas). 6'7 They may present as segmental strictures, 1'2 mimicking granulomatous colitis, 4'5'8 pol-
R E P O R T O F A CASE On December 13, 1989, a 65-year-old man with diarrhea was referred to the Endoscopy Unit. He had iron deficiency anemia and guaiac-positive stools. Physical examination revealed paleness and a left supraclavicular lymph node. Complete colonoscopy revealed approximately 20 polyps, ranging from 2 to 15 mm in diameter and polymorphic; the largest polyps were reddish with superficial erosions and were scattered over the entire colon, except for the rectum and ascending colon. Eight were removed with a diathermic snare. An esophagoduodenoscopy then revealed a large ulcer of the upper part of the fundus and multiple small polyps in the first and second duodena and the antrum, most of them umbilicated or ulcerated. Biopsy samples were taken from the ulcer wall. The eight colonic polyps analyzed were sessile and nodular, and their diameters ranged from 5 to 10 mm.
Figure 1. General view of a sessile colonic polyp, with nodular tumoral infiltration of submucosa and mucosa
Address reprint requests to Dr. Metayer: Service d'Endoscopie Digestive, H6pital Charles Nicolle, 76031 Rouen Cedex, France.
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REFERENCES
Figure 2. Colonic polyp. Typical aspect of signet ring cell carcinoma (x350).
Figure 3. Gastric biopsy. Poorly differentiated adenocarcinoma with scattered signet ring cell (x250). yps, or advanced tumors. 9 Polypous colonic m e t a s t a s e s usually c o m e f r o m m e l a n o m a s . 1~ I n the literature, w e have f o u n d a single case o f colonic polyposis metastatic from an extracutan e o u s c a r c i n o m a , w h i c h was renal. 11 This a p p e a r s to be the first r e p o r t e d case of colonic polyposis metastatic from a gastric carcinoma.
1. Fisher ER, Brown CH. Linitis plastica carcinoma of the stomach with extensive metastases simulating a colonic lesion. Gastroenterology 1952;20:503-8. 2. Dixon CF, Stevens GA. Carcinoma of linitis plastica type involving the intestine. Ann Surg 1936;103:26372. 3. Niimi K, Matsuki K, Tomoda S, Yoshinaka K, Nakano A, Hattori T. Two cases of solitary metastases to the large intestine from gastric carcinoma. Gan No Rinsho 1984;30:1720-5. 4. Katon RM, Brendler SJ, Ireland K. Gastric linitis plastica with metastases to the colon: a mimic of Crohn's disease. J Clin Gastroenterol 1989;11:55560. 5. M/inch R, Ammann R, Stamm B, et aL Linitis plastica des Kolons. Bericht 0bet drei f~ille unter spezieller Beriicksichtigung der Differentialdiagnose zur Kolitis Crohn. Schweiz Rundsch Med Prax 1985;74:14314. 6. Caramella E, Bruneton JN, Roux P, Aubanel D, Lecomte P. Metastases of the digestive tract: report of 77 cases and review of the literature. Eur J Radiol 1983;3:331-8. 7. Wigh R, duV Tapley N. Metastatic lesions to the large intestine. Radiology 1958;70:222-9. 8. Koop H, Dombrowski H, Maroske D, Schwerk WB, Schmitz-Moormann P, Arnold R. Segmentale Kolonstenosen bei intestinal metastasierendum Mammakarzinom. Ein Beitrag zur Differentialdiagnose der Kolitis. Dtsch Med Wochenschr 1988;113:1101-4. 9. Reintgen DS, Thompson W, Garbutt J, Seigler HF. Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract. Surgery 1984;95:635-9. 10. Sacks BA, Joffe N, Antonioli DA. Metastatic melanoma presenting clinically as multiple colonic polyps. AJR 1977;129:511-3. 11. Shousha S, Smith PA, Parkins RA. Metastatic spindlecell renal carcinoma presenting as multiple intestinal polyps. Dis Colon Rectum 1986;29:750-1.
The same pathologic abnormalities were found in all the polyps and around the gastric ulcer: infiltration of the mucosa and superficial part of the submucosa by a tumor composed of atypical epithelial clusters with the structure and differentiation of signet ring cell carcinomas (Figs. 1-3). The colonic polyps were therefore certainly metastatic from the gastric carcinoma. The patient died suddenly at home, in the last week of December 1989.
anemia, and left supraclavicular lymph node. [Key words: Colonic neoplasms; Colonic polyps; Stomach neoplasms; Digestive system neoplasms, secondary] Metayer P, Antonietti M, Oumrani M, Hemet J, Lemoine F, Basuyau J. Metastases of a gastric adenocarcinoma presenting as colonic polyposis: report of a case. Dis Colon Rectum 1991 ; 3 4 : 6 2 2 - 6 2 3 .
olonic metastases of gastric carcinomas are exceptional. 1-5 We report a case of diffuse colonic polypous metastases from a gastric adenocarcinoma.
C
DISCUSSION Among gastrointestinal metastases--colonic are rare, small intestine and gastric more frequent, and esophageal exceptional. 6 Colonic metastases generally originate from carcinomas of the breast, stomach, or skin (melanomas). 6'7 They may present as segmental strictures, 1'2 mimicking granulomatous colitis, 4'5'8 pol-
R E P O R T O F A CASE On December 13, 1989, a 65-year-old man with diarrhea was referred to the Endoscopy Unit. He had iron deficiency anemia and guaiac-positive stools. Physical examination revealed paleness and a left supraclavicular lymph node. Complete colonoscopy revealed approximately 20 polyps, ranging from 2 to 15 mm in diameter and polymorphic; the largest polyps were reddish with superficial erosions and were scattered over the entire colon, except for the rectum and ascending colon. Eight were removed with a diathermic snare. An esophagoduodenoscopy then revealed a large ulcer of the upper part of the fundus and multiple small polyps in the first and second duodena and the antrum, most of them umbilicated or ulcerated. Biopsy samples were taken from the ulcer wall. The eight colonic polyps analyzed were sessile and nodular, and their diameters ranged from 5 to 10 mm.
Figure 1. General view of a sessile colonic polyp, with nodular tumoral infiltration of submucosa and mucosa
Address reprint requests to Dr. Metayer: Service d'Endoscopie Digestive, H6pital Charles Nicolle, 76031 Rouen Cedex, France.
(x I 0). 622
Vol. 34, No. 7
COLONIC POLYPOUS METASTASES FROM A GASTRIC ADENOCARCINOMA
623
REFERENCES
Figure 2. Colonic polyp. Typical aspect of signet ring cell carcinoma (x350).
Figure 3. Gastric biopsy. Poorly differentiated adenocarcinoma with scattered signet ring cell (x250). yps, or advanced tumors. 9 Polypous colonic m e t a s t a s e s usually c o m e f r o m m e l a n o m a s . 1~ I n the literature, w e have f o u n d a single case o f colonic polyposis metastatic from an extracutan e o u s c a r c i n o m a , w h i c h was renal. 11 This a p p e a r s to be the first r e p o r t e d case of colonic polyposis metastatic from a gastric carcinoma.
1. Fisher ER, Brown CH. Linitis plastica carcinoma of the stomach with extensive metastases simulating a colonic lesion. Gastroenterology 1952;20:503-8. 2. Dixon CF, Stevens GA. Carcinoma of linitis plastica type involving the intestine. Ann Surg 1936;103:26372. 3. Niimi K, Matsuki K, Tomoda S, Yoshinaka K, Nakano A, Hattori T. Two cases of solitary metastases to the large intestine from gastric carcinoma. Gan No Rinsho 1984;30:1720-5. 4. Katon RM, Brendler SJ, Ireland K. Gastric linitis plastica with metastases to the colon: a mimic of Crohn's disease. J Clin Gastroenterol 1989;11:55560. 5. M/inch R, Ammann R, Stamm B, et aL Linitis plastica des Kolons. Bericht 0bet drei f~ille unter spezieller Beriicksichtigung der Differentialdiagnose zur Kolitis Crohn. Schweiz Rundsch Med Prax 1985;74:14314. 6. Caramella E, Bruneton JN, Roux P, Aubanel D, Lecomte P. Metastases of the digestive tract: report of 77 cases and review of the literature. Eur J Radiol 1983;3:331-8. 7. Wigh R, duV Tapley N. Metastatic lesions to the large intestine. Radiology 1958;70:222-9. 8. Koop H, Dombrowski H, Maroske D, Schwerk WB, Schmitz-Moormann P, Arnold R. Segmentale Kolonstenosen bei intestinal metastasierendum Mammakarzinom. Ein Beitrag zur Differentialdiagnose der Kolitis. Dtsch Med Wochenschr 1988;113:1101-4. 9. Reintgen DS, Thompson W, Garbutt J, Seigler HF. Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract. Surgery 1984;95:635-9. 10. Sacks BA, Joffe N, Antonioli DA. Metastatic melanoma presenting clinically as multiple colonic polyps. AJR 1977;129:511-3. 11. Shousha S, Smith PA, Parkins RA. Metastatic spindlecell renal carcinoma presenting as multiple intestinal polyps. Dis Colon Rectum 1986;29:750-1.
