The stomach represents an unusual site for metastatic lesions, and secondary tumors mimicking diffusely infiltrating primary gastric cancer are exceptionally rare [1]. With respect to prostate cancer, metastases to the upper gastrointestinal tract have only infrequently been described, and published data are mainly confined to single case reports [2]
[3]
[4].
A 69-year-old man diagnosed with prostate cancer 8 years earlier underwent upper endoscopy for unspecific abdominal discomfort. Inspection of the stomach revealed diffuse hypertrophic gastric folds within the upper third of the stomach ([Fig. 1]). Upon histological examination, the gastric oxyntic-type mucosa was found to be diffusely infiltrated by polymorphous cancer cells with enlarged irregular nuclei and cytoplasmic vacuolization ([Fig. 2]). The cancer cells were immunoreactive for prostate-specific antigen (PSA) ([Fig. 3 a]) and androgen receptor ([Fig. 3 b]). The MIB-1 proliferation index was 25 %.
Fig. 1 Hypertrophic folds arising within the upper third of the stomach.
Fig. 2 Polymorphous cancer cells diffusely infiltrating gastric oxyntic-type mucosa.
Fig. 3 The cancer cells are immunoreactive for: a prostate-specific antigen (PSA) and b androgen receptor.
Within the gastrointestinal tract, metastatic cancer is most often encountered as a solitary lesion resembling a submucosal tumor with or without a central depression and/or (“volcano”-like) mucosal ulceration. The lesions are typically located in the middle or upper third of the stomach [1]. Diffuse thickening of gastric folds and/or linitis plastica-like changes due to a secondary tumor are exceedingly rare and have, so far, mainly been reported for metastatic breast cancer [5]. To the best of our knowledge, metastatic disease due to prostate cancer has only once before been reported as a cause of hypertrophic gastric folds [4].
Differential diagnoses mainly include: Ménétrier’s disease, a rare hyperproliferative protein-losing gastropathy; lymphocytic gastritis, a rare variant of gastritis which is mainly associated with Helicobacter pylori infection; gastric lymphoma; and primary gastric cancer.
In conclusion, we present a case of hypertrophic gastric folds caused by metastatic prostate adenocarcinoma. Endoscopists should consider gastric metastasis in the work-up of patients with known malignancies who present with hypertrophic gastric folds.
Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB
