Muscle Metastases Revealing Gastric Signet Ring Cell Carcinoma: Case Report and Review of the Literature

Case Report

Austin J Clin Case Rep. 2019; 6(1): 1137.

Muscle Metastases Revealing Gastric Signet Ring Cell Carcinoma: Case Report and Review of the Literature

Mokhlis MA1*, Tanz R1, Mahfoud T1, Khmamouch R1, Debbagh A1, Errihani H2 and Ichou M1

1Department of Medical Oncology, Military Hospital, Mohamed V, Rabat, Morocco

2Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco

*Corresponding author: Mohamed Anouar Mokhlis, Department of Medical Oncology, Military Hospital, Mohamed V, Rabat, Morocco

Received: December 10, 2018; Accepted: January 08, 2019; Published: January 15, 2019


Advanced stomach cancer remains a serious disease with a poor prognosis. Skeletal muscle metastases of gastric carcinoma are extremely rare and may be revealing the disease. The signet ring cell carcinoma is defined by the presence of proportion of independent cells greater than 50%. In an advanced stage it has a more aggressive character with a greater risk of lymph node invasion or distant metastasis. The needle biopsy is required for diagnosis. The chemoresistance of SRCC appear as elements of poor prognosis. The armamentarium includes further the antitumor chemotherapy, radiotherapy and palliative care adapted to the patient’s clinical context.

Keywords: Muscle Metastasis; Signet Cell Carcinoma; Gastric Cancer; Chemoresistance


SRCC: Signet Ring Cell Carcinom; CT: Computer Tomography; MRI: Magnetic Resonance Imaging; FDG –PET: Fluorodeoxyglucose (FDG)-Positron Emission Tomography; FOLFOX: 5-Fluoro-Uracile, Leucovorin and Oxaliplatine; FOLFIRI: 5-Fluoro-Uracile, Leucovorin and Irinotecan


Gastric cancer is the second most common digestive cancer after colorectal cancer and the fourth leading cause of cancer death worldwide [1].

The most common metastatic sites are regional lymph nodes, liver, peritoneum, lung and bone. Gastric cancer can cause unusual metastases, such as gums, irises, testicles, muscles or even the meninges [2,3]. Muscular metastases are rare, only sporadic cases have been reported in the literature [4,5].

We report, in one patient, the case of a gastric adenocarcinoma with signet ring cells, which was revealed by the presence of muscular metastases.

Case Presentation

This is a 54-year-old Caucasian woman with a history of arterial hypertension who was admitted in July 2018 to manage a painful abdominal swelling affecting the right flank evolving for 2 months in a context of paroxysmal epigastralgia. On admission, she was 160cm tall and weighed 65kg. She had a temperature of 36.4°C, heart rate 82beats/min, blood pressure 140/70 mmHg. The abdominal examination found a hard and sensitive mass of the right flank, which was fixed in relation to the deep plane, the ganglionic areas were free, and the rest of the examination was without particularity.

Therefore, she received abdominal pelvic CT demonstrating irregular nodular thickening of the right transverse and the right rectus muscles of the abdomen with edematous diffuse infiltration of the next subcutaneous fatty tissue and a diffuse thickening of the cardiotuberotic and fundic region of 2cm thick (Figure 1). Subsequently, an ultrasound-guided biopsy of muscle swelling was conducted. The histological result with immunohistochemical complement (anti-CK7 +, anti-CK20 +, WT1-, ACE +, CDX2 + antibody) was in favor of muscle metastasis of gastric signet ring cell carcinoma (Figure 2 and 3). Endo-gastroduodenal fibroscopy showed a non-stenosing ulcerobourgonnant antral process. The histological diagnosis of the gastric biopsy showed a signet ring cell carcinoma with a background of chronic gastritis HP- and the HER2 status was negative.