LAUSR

A 22-year-old female had been previously diagnosed with undifferentiated gastric adenocarcinoma. She underwent distal gastrectomy with D2 lymphadenectomy, and reconstruction using a Finsterer retrocolic loop. Surgery was preceded and followed by four cycles of FLOT (Fluorouracil, Leucovorin, Oxaliplatin and Docetaxel) chemotherapy. The semi-annual follow-up with computed tomography (CT) showed no sign of recurrence or metastases. Two years after the initial diagnosis, the patient presented with multiple erythematous firm infracentemetric nodular lesions in the trunk, and three solid nodules of the scalp gradually increasing in size for approximately 2 months and measuring between 2 and 5 cm (Fig. 1). Surgical biopsies of the lesions were performed. The histopathologic analysis of the specimen showed the presence of clusters and trabeculae of signet-ring cells that infiltrate the dermis, consistent with the diagnosis of cutaneous metastases from gastric adenocarcinoma. Computed tomography of the chest, abdomen and pelvis showed local recurrence that developed at the surgical bed, peritoneal carcinomatosis, and pulmonary and liver metastases. Palliative chemotherapy was then recommended. Unfortunately, due to extensive metastatic disease, the patient passed away several weeks after the initiation of palliative chemotherapy. Commonly, gastric carcinoma metastasizes to the liver, regional lymph nodes and peritoneal cavity whereas it rarely displays cutaneous metastasis (0.8%–1%). Skin metastasis in gastric carcinoma usually presents as erythematous or hyperpigmented asymptomatic nodular lesions and more rarely, as cellulitis-like or erysipelas-like erythematous plaques, but histologic confirmation is crucial for the diagnosis. Cutaneous metastasis is, generally, associated with an advanced stage of the disease and a poor prognosis and the mean survival time of patients is only a few months. Treatment strategy depends on the diameter and number of lesions, the presence of other regional or distant metastases, and the performance status of the patient. It may include local excision, irradiation, or chemotherapy.