Stomach cancer presenting with rectal stenosis: Schnitzler's metastasis

Olano, Carolina; Simone, Federico De; González, Felipe; Gónzalez, Nicolás; Tchekmedyian, Asadur J; Pose, Ana; Iade, Beatriz

doi:10.1016/j.gie.2009.01.031

Cited by 8 publications

(14 citation statements)

References 1 publication

(2 reference statements)

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“…In our patient, metacronous Schnitzler's metastasis occured 42 months after completion of treatment for gastric adenocarcinoma. In the reported cases, the median disease-free survival after gastrectomy was 38 months (range: 18-72 months) for metachronous metastases [5][6][7][8][9][10][11][12]. The disease-free survival of the present patient was 42 months.…”

Section: Discussionmentioning

confidence: 73%

Rectal resection for Schnitzler’s metastasis in a patient presenting with severe rectal stenosis: case report and review of the literature

Doğan

Demirbaş

Samadov

et al. 2019

The European Research Journal

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Rectal metastasis resulting from the hematogenous spread of gastric cancer (Schnitzler's disease) is rarely seen. We report a case of 53-year-old female with rectal metastasis from gastic cancer who presented with abdominal pain, tenesmus, and severe constipation. Digital rectal examination revealed a severe stenosis 5-6 cm from the dentate line. Sigmoidoscopy showed a narrowed lumen at 5 cm up from the dentate line. The evident radiologic finding was circumferential stenosis of the rectum located at the same level. Very low anterior resection and total mesorectal excision with coloanal anastomosis in addition to protective ileostomy were performed. Pathological examination revealed metastatic adenocarcinoma (Schnitzler's metastasis). The patient was discharged on the 9 th postoperative day with no adverse events. It should be kept in mind that rectal stenosis could be metastasis from gastric carcinoma if consistent with the patient's history.

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Section: Discussionmentioning

confidence: 73%

Rectal resection for Schnitzler’s metastasis in a patient presenting with severe rectal stenosis: case report and review of the literature

Doğan

Demirbaş

Samadov

et al. 2019

The European Research Journal

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“…Similarly, Krukenberg tumor of the ovaries and Plummer's rectal shelf (tumor implants in the pouch of Douglas) are characteristic examples of metastatic peritoneal seeding. 2 However, scarce data exist on involvement of the rectum secondary to gastric adenocarcinoma. 6…”

Section: Discussionmentioning

confidence: 99%

“…1 Primary gastric carcinoma arises from the gastric mucosa, and distant metastasis may occur via the venous, lymphatic system and/or peritoneal seeding. 2 Rectal stenosis, an atypical presentation of advanced gastric carcinoma, may be associated with peritoneal dissemination or less commonly as a result of spread of the poorly differentiated signet ring cell adenocarcinoma within the rectal submucosa via the lymphatic system (Schnitzler's metastasis). 2,3 The stomach, colon, and breast are sites of origin of signet ring cell carcinoma (SRCC) in the majority (90%) of cases.…”

Section: Introductionmentioning

confidence: 99%

“…2 Rectal stenosis, an atypical presentation of advanced gastric carcinoma, may be associated with peritoneal dissemination or less commonly as a result of spread of the poorly differentiated signet ring cell adenocarcinoma within the rectal submucosa via the lymphatic system (Schnitzler's metastasis). 2,3 The stomach, colon, and breast are sites of origin of signet ring cell carcinoma (SRCC) in the majority (90%) of cases. This particular subtype of adenocarcinoma has the propensity to metastasize early in the clinical course.…”

Section: Introductionmentioning

confidence: 99%

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Blocked by a Ring: A Case of Gastric Linitis Plastica Presenting as Large Bowel Obstruction Secondary to Rectal Stenosis

et al. 2019

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Metastatic gut lesions from primary gastric carcinoma occur via hematogenous, lymphatic, or peritoneal seeding. We report an unusual case of large bowel obstruction secondary to rectal stenosis due to metastatic signet ring cell gastric cancer. A 61-year-old woman with a history of 8 weeks' duration of alternation in bowel movements presented with symptoms of bowel obstruction. Computed tomography revealed rectal wall thickening, and sigmoidoscopy demonstrated edematous and fibrotic rectal mucosa. Superficial biopsies were negative for malignant disease. Because of worsening of obstructive symptoms, an emergent surgical diversion was performed. Surgical biopsies were consistent with poorly differentiated adenocarcinoma. Gastroscopy established diagnosis of gastric adenocarcinoma with signet ring type cells. Rectal stenosis on examination and demonstration of rectal wall thickening on imaging should raise suspicion for Schnitzler's metastasis, and an upper endoscopy should be performed.

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“…The rectal stenosis can be an atypical sign of gastric cancer and can to occur as a result of peritoneal dissemination of disease or, rarely, as result of lymphangitic spread of poorly differentiated signet‐ring cell adenocarcinoma within the submucosa of the gastrointestinal tract (Schnitzler's metastasis). In published case reports, lymphangitic involvement of the rectum is associated with a widespread extension of disease and, more often, metachronously 1–3.…”

Section: To the Editormentioning

confidence: 99%

Unusual rectal stenosis

Rausei

Frattini

Dionigi

et al. 2010

Journal of Surgical Oncology

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We briefly present a case of a 58-year-old man with a 3-month history of dyspepsia, constipation, and tenesmus recently referred to our emergency department for evaluation of abdominal pain and recurrent vomiting.Medical history did not show any relevant problems. On presentation to the emergency department our patient was afebrile, with all other vital signs within normal limits. On physical examination, his abdomen was mildly distended, with diffuse pain on palpation; there was no guarding or rebound tenderness. Rectal exploration revealed a hard, concentric stenosis 6 cm from the anal verge. Results of blood tests, chest radiography, and an ECG were normal. An abdominal computed tomography showed a thickening of the gastric antrum and, simultaneously, confirmed an extended concentric stenosis of the whole rectum from the sigmoid junction to the anal verge (Fig. 1a,b). Endoscopic evaluations detected a wide substenotic ulcerative lesion of the medium and distal thirds of stomach and a strict insuperable stenosis of lower rectum with apparently normal mucosa. The gastric biopsies revealed a signet-ring cell gastric adenocarcinoma and histopathological findings of the rectum samples did not show any sign of tumoral involvement. Magnetic resonance of the pelvis confirmed an asymmetric thickening of the proximal rectum and a symmetric concentric stenosis of the medium-distal rectum along with some lymphadenopathies within mesorectum and presacral space. Laparotomy was performed with a working diagnosis of non-metastatic locally advanced gastric cancer, but surgical findings also included a hardening of rectal and perirectal tissue below the peritoneum. A total gastrectomy and a lateral decompressive left colostomy, along with a number of biopsies of perirectal tissue, were performed. Histopathological findings were consistent with signetring cell adenocarcinoma of stomach (with muscular layer and nodal involvement) and with infiltration of signet-ring cell adenocarcinoma of the rectal wall. Subsequently, the patient was referred for adjuvant chemotherapy.The rectal stenosis can be an atypical sign of gastric cancer and can to occur as a result of peritoneal dissemination of disease or, rarely, as result of lymphangitic spread of poorly differentiated signet-ring cell adenocarcinoma within the submucosa of the gastrointestinal tract (Schnitzler's metastasis). In published case reports, lymphangitic involvement of the rectum is associated with a widespread extension of disease and, more often, metachronously [1][2][3]. This is the first reported case with synchronous Schnitzler's metastasis associated with a (otherwise non-metastatic) primary gastric cancer.

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Stomach cancer presenting with rectal stenosis: Schnitzler's metastasis

Cited by 8 publications

References 1 publication

Rectal resection for Schnitzler’s metastasis in a patient presenting with severe rectal stenosis: case report and review of the literature

Rectal resection for Schnitzler’s metastasis in a patient presenting with severe rectal stenosis: case report and review of the literature

Blocked by a Ring: A Case of Gastric Linitis Plastica Presenting as Large Bowel Obstruction Secondary to Rectal Stenosis

Unusual rectal stenosis

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