Case Brain Metastases in Patient with Gastric Cancer

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Brain Metastases
Contrast-enhanced T1-weighted images of the brain. (a) There is a ring enhancing approximately 3 cm mass (white thick arrow) in the right temporoparietal region with surrounding edema. This results in effacement of the right lateral ventricle and mild leftward midline shift. This was the dominate mass of the 3 lesions initially identified. (b) Similar smaller ring enhancing lesion (white thin arrow) in the right frontal lobe with surrounding edema.

Isolated Brain Metastases from Gastric Cancer

This article describes the case of a rare occurrence of isolated brain metastases from gastric cancer in a 68-year-old Albanian male patient. The patient’s medical history revealed hepatitis B with signs of progressive dysphagia to solids. Doctors advised barium swallow for further evaluation and to rule out the possibility of esophageal dysmotility problem. In addition, advised an ultrasound which showed no acute findings.

A subsequent esophagogastroduodenoscopy was also performed which revealed a nodule in the distal esophagus, including a large, friable and ulcerated mass which extended to the gastroesophageal junction along the gastric cardia. Pathological analysis of the nodules showed adenocarcinoma, intestinal type, with neoplastic glands which infiltrated the muscularis mucosae. The biopsied nodule showed high-grade dysplasia, whereas antral biopsy showed reactive mucosa. The patient’s cancer was staged using positron emission tomography scans.

The scans confirmed the diagnosis of gastric mass with presence of two fluorodeoxyglucose avid lymph nodes.

Treatment included neoadjuvant chemotherapy with epirubicin, oxaliplatin, and capecitabine. In addition, doctors advised a total gastrectomy with esophagojejunal anastomosis. The patient was treated with paclitaxel, capecitabine, and pegfilgrastim kit following surgical resection.

A year later, the patient presented with a 3-6-week history of photophobia, nausea, dizziness, falls and holocranial headaches. MRI of his head without contrast showed three peripherally enhancing lesions in the right cerebral hemisphere with oedema in the surrounding. The largest lesion was present in the right temporoparietal lobes. This caused a mass effect with midline shift. The patient underwent right temporoparietal craniotomy to resect the largest tumour.

He subsequently underwent gamma knife radiosurgery for the remaining two metastases. Similarly, he was also offered systemic chemotherapy, however, he declined and went for close monitoring. The patient, as of July 2018 is stable with no new brain lesions or evidence of metastases.

References

A Rare Occurrence of Isolated Brain Metastases from Gastric Cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360578/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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