Clinicopathologic findings in a cohort of metastases to the stomach

IF 2.7 2区医学 Q2 PATHOLOGY

Human pathology Pub Date : 2024-11-22 DOI:10.1016/j.humpath.2024.105694

Trevor Toussieng , Brent K. Larson , Miguel Burch , Alexandra Gangi , Jun Gong , Maha Guindi , Michael Kozak , Keith Lai , Danielle A. Hutchings , Kevin M. Waters

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Abstract

Aims

Metastatic tumors to the stomach can mimic primary gastric adenocarcinoma or be subtle and difficult to identify. The current study aimed to characterize the clinicopathology of metastases to the stomach to aid in diagnosis.

Methods and results

Forty-three metastatic tumors and 30 primary gastric adenocarcinoma cases were reviewed. Metastases originated from numerous primaries with the most common being mammary (n = 17) or melanoma (n = 9). The gastric metastasis represented the initial diagnosis for 9 (21%) cases without previous history of malignancy. The median age at diagnosis was similar (metastatic 66 years; primary 67.5 years; P = 0.42). The most common indication for procedure was abdominal pain (23%; P = 0.95) in metastases and melena (43%; P < 0.01) in primaries. Procedural findings suggestive of metastasis over primary adenocarcinoma were multiple lesions (23% versus 0%; P = 0.01), non-mass forming mucosal changes (30% versus 0%; P < 0.01), submucosal nodularity (14% versus 0%; P = 0.09), and absence of ulceration (9% versus 53%; P < 0.01). Histologic findings less commonly seen in metastasis were mucosal layer involvement (86% versus 100%; P = 0.09), ulceration (40% versus 70%; P = 0.02), surface epithelial involvement/colonization by tumor (12% versus 60%; P < 0.01), intestinal metaplasia (9% versus 53%; P < 0.01), background dysplasia (0% versus 30%; P < 0.01), and Helicobacter pylori infection (0% versus 20%; P < 0.01). Lymphovascular invasion had similar prevalence (metastatic 23%; primary 20%; P = 0.70).

Conclusions

Metastasis to the stomach included a variety of primary sites and was not infrequently the initial diagnosis. Patient demographics were similar to primary adenocarcinoma. Multiple lesions, non-mass forming mucosal changes, and/or submucosal nodularity were more common in metastasis. Histologically, the absence of surface epithelial involvement, ulceration, intestinal metaplasia, background dysplasia, or H. pylori infection can raise suspicion for metastasis.

Abstract Image

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胃部转移瘤群的临床病理学发现

目的：胃转移性肿瘤可能与原发性胃腺癌相似，也可能很隐蔽，难以识别。本研究旨在描述胃转移瘤的临床病理特征，以帮助诊断：研究回顾了 43 例转移瘤和 30 例原发性胃腺癌。转移瘤来自多个原发部位，其中最常见的是乳腺癌（17 例）或黑色素瘤（9 例）。9例（21%）病例的最初诊断为胃转移瘤，既往无恶性肿瘤病史。诊断时的中位年龄相似（转移瘤 66 岁；原发性 67.5 岁；P=0.42）。最常见的手术指征是转移瘤的腹痛（23%；P=0.95）和腹泻（43%；PConclusions）：胃部转移包括多种原发部位，而且并非罕见的初步诊断。患者的人口统计学特征与原发性腺癌相似。多发病变、非肿块型粘膜病变和/或粘膜下结节在转移瘤中更为常见。从组织学角度来看，如果没有表面上皮受累、溃疡、肠化生、背景发育不良或幽门螺杆菌感染，则可怀疑为转移瘤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Human pathology 医学-病理学

CiteScore

5.30

自引率

6.10%

发文量

206

审稿时长

21 days

期刊介绍： Human Pathology is designed to bring information of clinicopathologic significance to human disease to the laboratory and clinical physician. It presents information drawn from morphologic and clinical laboratory studies with direct relevance to the understanding of human diseases. Papers published concern morphologic and clinicopathologic observations, reviews of diseases, analyses of problems in pathology, significant collections of case material and advances in concepts or techniques of value in the analysis and diagnosis of disease. Theoretical and experimental pathology and molecular biology pertinent to human disease are included. This critical journal is well illustrated with exceptional reproductions of photomicrographs and microscopic anatomy.