A patch-like lesion in stomach

A 61-year-old woman with underlying disease of hypertension, type II diabetes mellitus, and newly diagnosed lung adenocarcinoma visited our outpatient department because of general fatigue with body weight loss for 2 months. Panendoscopy for anemia showed a patch-like lesion at the great curvature of the middle body (Figure 1A, arrows). Using narrow band image, there was no significant irregular vascularity, but with clear demarcation of the lesion (Figure 1B, arrows).

What is your impression for this patient?

1.  Gastric cancer

2.  Gastric intestinal stromal tumor

3.  Gastric metastasis

4.  Erosive gastritis

Pathology of tissue biopsy revealed gastric mucosa infiltrated by angulated atypical glands composed of cells with large and hyperchromatic nuclei (Figure 2A, arrow). The immunohistochemical stain demonstrated strong positive for cytokeratin (CK), cytokeratin 7 (CK7) and thyroid transcription factor-1 (TTF-1) (Figure 2B), and negative for cytomegalovirus (CMV), and cytokeratin 20 (CK20). It was diagnosed to be a lung cancer with gastric metastasis.

The incidence of lung cancer is the highest in the global world.¹ However, the gastrointestinal metastasis with mucosal invasion is rare, and has extremely variable morphology. Therefore, a cauliflower-like patch should be a differential diagnosis of gastric metastasis.

The authors declare no conflicts of interest.

The study complies with current ethical considerations, and an informed consent was signed by the patient.