A rare case of metastatic germ cell tumor to stomach and duodenum masquerading as signet ring cell adenocarcinoma

Abstract

Adenocarcinomas are the most common cancers affecting stomach. However gastrointestinal stromal tumors (GIST), lymphomas and neuroendocrine tumors (NETs) can also affect the stomach. But stomach is relatively rare site of involvement by metastasis. In this case report a rare metastasis of germ cell tumor (GCT) into stomach is described which clinically and endoscopically masquerade as primary gastric cancers. But detailed clinical examination and vigilant histopathological reporting proves the origin of tumor distant from stomach and thereby change the whole approach of management.

Seminoma presenting as a solitary metastasis in gastric mucosa with regressed testicular mass

“…Gastric involvement by seminoma is extremely rare; with only a few reported cases in the English literature 1, 2, 3. Most of the cases were associated with bulky retroperitoneal disease or occurred late as part of advanced disease.…”

“…When GCTs metastasize, the primary landing sites are the retroperitoneal lymph nodes, while organ metastases occur in more advanced stage. Gastric metastasis as the initial presentation of a seminoma has been only very rarely reported 1, 2, 3. The “burned-out phenomenon” in germ cell tumors is a very rare but well documented event 4 .…”

Metastatic seminoma with isolated gastric metastases: a case report

“…The most commonly reported cancers associated with gastric metastasis are breast, lung, renal and melanoma. 3 Published findings of gastric metastases arising from GCTs tend to be limited to single case reports (Table 1), [4][5][6][7][8][9][10] with some additional case reports of GCT metastasis to other areas of the GI tract. 18 Most reported cases of gastric metastases from GCTs are NSGCTs (Table 1), occur in the age range 15-35 (where incidence is highest), have retro-peritoneal lymph node involvement and visceral metastatic involvement of sites other than the gastric mucosa (often representing advanced disease).…”

“…Metastatic spread often occurs via the lymphatic system to retroperitoneal lymph nodes, and haematogenous spread most commonly to the lungs (2). Gastric metastases are a rare presentation of any solid malignancy (3) and have only been rarely reported in the setting of a germ cell primary (Table 1) (4)(5)(6)(7)(8)(9)(10).…”

“…2 Gastric metastases are a rare presentation of any solid malignancy 3 and have only been rarely reported in the setting of a germ cell primary (Table 1). [4][5][6][7][8][9][10] We present a case of a 67-year-old man, with a background of myelofibrosis, who was diagnosed with metastatic seminoma following an endoscopy for dyspepsia. Further investigation revealed isolated gastric mucosal disease as his sole extra-testicular site of disease.…”