Metastatic Adenocarcinoma in the Brain - Erler Zimmer

Metastatic Adenocarcinoma in the Brain - Erler Zimmer

Clinical History

A 56-year-old male underwent a total gastrectomy and splenectomy for gastric adenocarcinoma. Over two months, he developed a progressively unsteady gait, increasing weakness of his left hand, and frontal headaches associated with nausea and vomiting. Imaging revealed a lesion in the right frontal lobe. A craniotomy with resection of the lesion confirmed metastatic gastric adenocarcinoma. Gradual worsening symptoms, jaundice, deteriorating consciousness, and papilledema from increased intracranial pressure ensued. Repeat imaging showed recurrence of the right frontal metastatic lesion and liver metastases. The patient passed away 9 months after the initial gastrectomy surgery.

Pathology

This brain specimen, cut in the coronal plane, displays a circumscribed, variegated, pink-grey tumor in the right frontal lobe, involving both grey and white matter. Compression of the right lateral ventricle by the lesion is evident, along with a shift of midline structures.

Further Information

Stomach cancer stands as one of the most common causes of cancer-related death globally. Risk factors include male gender, diet, smoking, and chronic Helicobacter pylori infection. Gastric adenocarcinoma most commonly metastasizes to the liver, peritoneum, lungs, and bones. Brain metastases are rare, occurring in less than 1% of cases. Isolated brain metastases are particularly uncommon, with a higher prevalence in disseminated disease and a correlation with a poor prognosis. Palliative treatment may involve surgery, radiotherapy, steroids, chemotherapy, or a combination of these approaches.