Solitary metastasis of gastric carcinoma in the right rectus abdominis muscle 15 years after total gastrectomy

Background. Recurrence of gastric carcinoma most often occurs within 5 years after radical surgery, with 60–70 % of recurrence detected within first two years and 4–5 % after 5 years. The liver and peritoneum are the most common sites of gastric cancer recurrence, but it can also spread to other distant sites. Metastases to skeletal muscle from any primary tumor are rare, with a reported incidence ranging from 0.03 to 0.16 %. Isolated hematogenous metastasis bypassing the portal and pulmonary circulation from gastric primary is a rare event. Here we report a case of a patient who developed isolated solitary metastasis in the right rectus abdominis muscle 15 years after total gastrectomy (without perioperative or adjuvant chemotherapy) for gastric carcinoma.

Case presentation. A 64-year-old patient who had undergone gastrectomy for gastric cancer 15 years earlier presented with a tumor in the right rectus abdominis muscle. Histopathological examination of the ultrasound-guided Tru-Cut biopsy confirmed the presence of adenocarcinoma. A CT scan of the chest, abdomen, and pelvis, as well as a colonoscopy, revealed no synchronous primary tumor. Wide excision of the tumor was performed, including full-thickness abdominal wall resection, with reconstruction of the defect using polypropylene mesh.

Conclusion. Our case report demonstrates that gastric cancer metastases to skeletal muscle can occur even 15 years after a curative gastrectomy. In other words, the detection of soft tissue tumors developing in patients even 15 years after gastrectomy for gastric cancer does not rule out the possibility of metachronous metastasis from the primary gastric tumor.

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