A 6-Year Controlled Gastric Adenocarcinoma Metastasized to the Lung, Cervical Spine and Mandible in a Japanese Male: A Patient Report

Gastric adenocarcinoma metastasized to the lung, cervical vertebrae and mandible 6 years after gastrectomy in a 70-year-old man. When the man visited our clinic, he complained of pain in the left mandible with paralysis in the left lower lip and diffuse swelling with a fluctuation inside the left ramus of the mandible. Medium contrast computed tomography (CT) presented bone loss that looked like a wormhole at the left angle of the mandible. Magnetic resonance imaging (MRI) revealed abscess or osteomyelitis at the site. He showed no response despite treatment with antibiotics, and we suspected a neoplastic lesion. With a mandibular ramus specimen obtained by biopsy and examined histopathologically, adenocarcinoma of the salivary gland was strongly suspected. MRI presented a neoplastic lesion in his cervical vertebrae, and by biopsy he was diagnosed with adenocarcinoma. Thereafter, chest CT presented multiple pulmonary metastases. Considering the patient’s history of gastrectomy due to gastric adenocarcinoma, the stomach, cervical vertebrae or mandible were examined pathologically and immunohistochemically by biopsy: all specimens showed a moderately differentiated type of tubular adenocarcinoma, and the results for cytokeratin-related tumor markers were the same. We finally diagnosed him as having metastases from gastric adenocarcinoma to the lung, cervical vertebrae and mandible. Because the metastases had spread to multiple organs, the mandibular lesion was not treated, and terminal care in another facility was unavoidably selected. In making a differential diagnosis of multiple metastases, pathological and immunohistochemical examinations of metastatic lesions by biopsy were very useful based on the diagnostic imagings by CT and MRI.