Abstract
Is the real pain on the neck?: A case of Gastric Adenocarcinoma with Metastasis to the Thyroid.
Yusi, Jan Axel L., Cataluna, Jose MD
Significance: The main pathways of metastasis of gastric Cancer is through lymphatic and hematogenous spread. It is common for patients with gastric cancer to develop distant metastasis in the liver, lung bone and brain. Metastasis to the thyroid gland is rare even if it has an abundant blood supply. Metastasis of gastric cancer to the thyroid is rare and is associated with poor prognosis
Clinical Presentation: Patient is a 67/F, known case of Hurthle Cell carcinoma diagnosed 2 months prior to index admission when the patient then presented with an enlarging anterior neck mass. She was then admitted 2 months post-operatively due to Acute Cerebral Infarct. Patient then had an episode of melena while being managed for the neurologic condition.
Management: Upper Gastrointestinal endoscopy was done revealing an irregularly shaped, circumferential, ulcerating mass with friable mucosa from the distal corpus up to the proximal antrum. Biopsy from the Gastric mass revealed an ulcerating adenocarcinoma with lymphovascular invasion present. IHC staining done with the gastric specimen favored a primary gastric carcinoma. Subsequent IHC staining requested for the thyroid specimen eventually revealed a metastatic adenocarcinoma of gastric origin.Upper Gastrointestinal endoscopy was done revealing an irregularly shaped, circumferential, ulcerating mass with friable mucosa from the distal corpus up to the proximal antrum. Biopsy from the Gastric mass revealed an ulcerating adenocarcinoma with lymphovascular invasion present. IHC staining done with the gastric specimen favored a primary gastric carcinoma. Subsequent IHC staining requested for the thyroid specimen eventually revealed a metastatic adenocarcinoma of gastric origin.
Recommendation: In patients presenting with cancer of another organ, a metastatic lesion from a digestive tract origin should be considered. Immunohistochemical staining is a modality that can be done to ascertain the primary organ of origin.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |