Analysis of stomach metastasis resulting from different cancers in a retrospective review

doi:10.21203/rs.3.rs-3594111/v1

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Analysis of stomach metastasis resulting from different cancers in a retrospective review

https://doi.org/10.21203/rs.3.rs-3594111/v1

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Context and purpose

Research reviews the findings, course of therapy, and outcomes of gastric metastases (GM). With this investigation, we hope to contribute to the increasing amount of information by providing practitioners with a reliable and practical platform for understanding stomach metastases from various primary malignancies.

Methods: This study covered papers published in English from the MEDLINE and Cochrane databases until May 2022. The deleted materials included editorial emails, billboards, surgical photos, and non-English publications. Hematogenous and lymphogenic metastases were noted, yet primary tumor progression and dissemination were not. Using pre-established criteria for eligibility, the ultimate selection was made after the articles and abstracts were reviewed and cross-referenced.

Results: A total of 186 GM cases were listed in 1,521 papers that were eventually found. The average of sixty-two years. The majority of GM cases (67) were attributed to reproductive cancers, with lung tumors (33 patients), carcinoma of the kidney (20 patients), and melanomas (19 patients) trailing closely behind. The main treatment strategy for metastases is excision surgery (n = 62), often in combination with immunotherapy or chemotherapy (ChT). Among the 78 therapeutic options, ChT was the second-most preferred choice. Furthermore, immunotherapy was one of the most preferred treatment alternatives (n = 10) following surgery and ChT.

Conclusions: Heterogeneity was inevitable because 172 case reports from different journals were included in this systematic review. Certain papers have omitted crucial facts such as comprehensive monitoring and scientific information. Additionally, since every article featured was a personal study, it was not possible to evaluate the quality of the work. In the majority of the 172 cases that were examined, resected procedures occurred; on rare occasions, immunotherapy and ChT were also combined. The best course of action for patients with stomach metastases requires further investigation.

Surgery

gastric cancer

stomach cancer

gastric metastases

Stomach metastases are uncommon and have poor prognosis. It can cause fatigue, nausea, vomiting, a lack of appetite, abdominal discomfort, and other systemic symptoms. Based on the clinical and autopsy results, the incidence of stomach metastases has been reported to be between 0.2–0.7% [1]. The site of origin of the tumor, along with the type and grade of the tumor, should be considered when planning the treatment for gastric metastases. Currently, gastrectomy is the only curative treatment for metastatic gastric cancer. Consequently, patients with multifocal high-grade malignancies might benefit from chemotherapy. The literature on the diagnosis, course of therapy, and results of stomach metastases was reviewed in this study.

Lymphatic drainage and blood supply are the main mechanisms by which metastatic illness from malignant tumors spreads. As a result, certain organs are far more likely to metastasize than others are. Depending on the type and location of the main tumor, this is the case for the liver, lungs, and locoregional lymph nodes. Although metastases can generally form at any location in the body, distant metastases typically occur more frequently in late stages of cancer. The stomach can house metastases from different malignancies but is often the source of metastatic disease, primarily from advanced gastric cancer. The main findings regarding stomach metastases are summarized in this brief review.

By analyzing case reports of various primary tumors independently, considering the diagnosis, treatment, and clinical presentation, which can differ from patient to patient depending on the primary site of the tumor, this study aimed to provide clinicians with a trustworthy and helpful resource for understanding gastric metastases resulting from a variety of primary tumors. It also presents an expanding body of literature in an easily readable format.

Regularity

of Stomach metastases is uncommon. It has been observed that the incidence varies between 0.2 and 0.7% in clinical and autopsy series [1, 2]. Most reports in the literature deal with single case series or case presentations. This raises unanswered questions regarding the molecular processes of stomach metastases and their underlying pathophysiological states. Gastric metastases can spread via hematogenous dissemination, peritoneal dissemination, lymphatic infiltration, or direct invasion.

It has been noted that among primary tumor entities moving to the stomach, malignant melanoma (7%) and lung cancer (23%), breast cancer (27%), and renal cell carcinoma (7.6%) are among the most common [3]. Moreover, leukemia and lymphoma infiltration into the stomach is possible [3].

Endoscopic Results

It is common to see brownish or black flat or elevated patches or lesions on the mucosa in cases of malignant melanoma [4, 5]. Nonetheless, amelanotic melanoma metastases are typically unpigmented, and stomach amelanotic metastases from primary melanotic melanoma have been reported [6].

[2]. In addition, lesions may manifest as ulcers [4], polypoid masses [8], or ulcerated projecting lesions [7, 9]. In contrast to the endoscopic categorization methods for gastric cancer, which make it easy to distinguish a gastric lesion from a metastasis, there is no characteristic pit pattern. This emphasizes the necessity of sufficient biopsy sampling to determine the precise nature of ambiguous stomach mucosal lesions [10].

Clinical presentation

According to a review by Namikawa and Hanazaki [3], patients with stomach metastases typically range in age from 56 to 71 years old, and there is an average 16–78 month interval between the initial diagnosis of cancer and the gastric metastases. Interestingly, gastric metastases of renal cell cancer and breast cancer occurred later than the first tumor diagnosis (75.6 and 50–78 months, respectively).

Gastric metastases do not usually appear in the clinical practice. There have been reports of vomiting, dysphagia, and epigastric pain [7]. Many individuals with gastrointestinal hemorrhage are discovered accidentally during staging endoscopies, which are performed in relation to a primary tumor that is known to exist or even in an attempt to find a primary tumor.

In a set of 37 cases, the median survival period following the discovery of stomach metastases was 3 months, with a range of 1–11 months. Individuals who experienced a single stomach metastasis had a longer survival than those who experienced several metastases [7]. Nonetheless, the nature and stage of the underlying tumor are fundamental determinants of survival.

It is important to be aware of late-onset stomach metastases, which may appear years after the initial diagnosis of a cancerous condition. An instance of stomach metastasis occurring 20 years after renal cell cancer was reported by Onorati et al. [12]. Twelve years after the original diagnosis, Sofos et al. [13] reported stomach metastasis from uveal melanoma, while Mehrzad et al. [14] reported late prostate cancer metastasis with a nine-year latency.

Counseling

Although typically isolated, gastric metastases can spread throughout the stomach, as in malignant melanoma. Surgery is typically not used as a therapy for stomach metastases because they usually occur in the later stages of a malignant disease and require systemic chemotherapy for the main tumor. Endoscopy or surgery [15] is used to treat local problems, such as bleeding or blockage, with the goal of providing palliative care. Stent and standard endoscopic hemostatic treatments are the preferred treatment methods. Gastric surgery should be considered when treating tumor types, such as renal and colon cancers, that may require metastatic surgery to improve prognosis. The justification for surgery is evidence that stomach metastasis is isolated, and that a thorough diagnostic workup is necessary.

Patients with gastric metastases have a longer life than patients with other original tumors, owing to tailored chemotherapy regimens for breast cancer and renal cell carcinoma [3].

: This systematic review follows

Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Criteria. [171]. A computerized literature search was performed through May 2022, using the Cochrane and MEDLINE/PubMed databases.

The following set of keywords was used for the search: ({({gastric (MeSH Terms)} AND {neoplasm metastasis (MeSH Terms)}) OR (gastric metastases}) OR (metastasis to the stomach). Filtering for "free full text" and "case reports" restricted the scope of the search. Two reviewers independently examined and retrieved each report following the team's judgment of the inclusion and exclusion criteria.

This study included both hematogenous and lymphogenic metastases; however, it did not include direct tumor invasion or seeding. Posters, editorial letters, clinical photographs, and articles written in languages other than English were not included. Reviewers were grouped according to the primary tumor location after the studies were screened and classified according to the inclusion and exclusion criteria. To gather data from studies in a particular area, such as metastasis from lung malignancies or gynecologic cancers, each group was reviewed by two reviewers.

The following data were obtained from the databases: first author, total number of cases, age, sex, primary tumor site, histology and treatment of the primary tumor, metastatic treatment, clinical presentation of gastric metastases (GM), synchronous or metachronous GM, interval between primary and secondary GM, diagnostic procedures, other metastases, and overall survival.

The Discussion section of the paper mentions that bias risk assessment was not conducted because the study solely consisted of screening case reports.

Reporting Items for Systematic Reviews and Meta-Analyses present in Fig. 1

After 1,521 publications were found, 170 (101 female and 85 male) were ultimately included, representing 186 patients with GM. The patients’ ages ranged from 55 to 62 years (IQR: 55−70.5). The most prevalent cancer type producing GM was gynecological cancer (including breast cancer), affecting 66 patients. There cancer (33 patients), 20 with renal cancer (20 patients), and melanoma (19 patients) followed (Fig. 2). The findings are displayed below, based on the origin of the original tumor. The most common treatment for metastasis was resection surgery (n = 62; total, subtotal, or partial gastrectomy; wedge gastrectomy; radical total gastrectomy with Roux-en-Y; and laparoscopic resection of gastric metastasis) occasionally in conjunction with immunotherapy or chemotherapy (ChT). Chemotherapy was the other most commonly used treatment (N = 78). Following surgery and chemotherapy, immunotherapy was one of the most popular treatment options (N = 10).

Gynecological metastasis

Of 66 patients, 57 were included in the median age group. A total of 46 patients developed metastases other than GM. Metastasis occurs most frequently in bones. No additional metastases were found in five patients. In the breast cancer group, there were 54 instances, and one patient was male. The youngest patient in the breast group was 36 years old, while the oldest was 84 years old. The median age of the patients was 56. Invasive lobular carcinoma (ILC) accounts for the largest number of ovarian and uterine cancers worldwide. Thirteen patients had ILC upon presentation. Nine patients in the ovarian group with a median age of 61 years were included. At 73 years of age, the oldest patient was the youngest, at 47 years of age. Two patients, aged 49 and 80 years, were included in the uterine group. Surgery is not always as effective as systemic medications. Palliative care includes surgical procedures. Chemotherapy is the most commonly used systemic treatment for HCC. Only 25 cases provided an overall survival rate, which may range from a few days to nine years. Of all patients, six were still living. The conclusions of the included studies regarding gynecological malignancies are summarized in Table 1 [2–56].

Cancer of the gastrointestinal tract

The 16 patients (11 men and 5 women) ranged in age from 22 to 85 years with a median age of 69. The seven individuals for whom data were available had overall survival times ranging from two to 16 months. Despite this, the survival of three patients was not reported, leaving six patients alive. The most prevalent histological type of gastrointestinal malignancy was adenocarcinoma (Adeno Ca), which affected seven patients. Hepatocellular cancer (HCC) and squamous cell carcinoma (two cases) were the most common histological types. Endoscopy is the most commonly used technique for diagnosing metastases. Other diagnostic techniques include endoscopic ultrasound, positron emission tomography-CT (PET-CT), and computed tomography (CT). Laparotomy and biopsy were performed in one subject. Nine of these patients underwent surgery in this study. One patient underwent transcatheter left gastric artery embolization. Conversely, one patient underwent palliative radiation, while seven others underwent chemotherapy. However, no one knows about the sufferer. Table 2. [57–72] provides an overview of data on gastrointestinal cancers.

Cancer of the lung

The ages of the 33 patients ranged from 39 to 78 years, with a median age of 62 years (25 males and 8 females). In addition to stomach metastases, 27 patients also had metastases. The data provided for 22 patients showed survival durations ranging from two weeks to 30 months. However, four and five years after metastases were discovered, respectively, and two individuals were still alive. The most common histological form of primary lung malignancy that results in stomach metastases is adenocarcinoma, which was diagnosed in 13 patients. Small cell lung cancer (SCLC) and squamous cell carcinoma (SCC) are the most common histological types. Different combinations of chemotherapy were the most frequently chosen treatment course for GM (15 cases). Conversely, of all the instances, seven underwent surgery (one for esophagogastrostomy, two for total gastrectomy, and four for partial gastrectomy). However, one patient was not eligible for gastrointestinal treatment because his metastasis was discovered only after autopsy. In addition, the treatment for six other cases was unknown, and one patient declined metastatic care. Table 3. [73–102] provides an overview of GM data resulting from primary lung tumors.

Adverse melanoma

The 19 patients (seven females and 12 males) ranged in age from 28 to 89 years, with a median age of 67. In addition to malignant melanoma, organ metastasis was observed in 16 patients. In ten cases, OS was not associated of overall survival. One patient died after a year, and the other two cases died two and four days after being admitted to the hospital, respectively. In addition, two of these individuals were still alive at six months and five years, respectively. Three patients had an overall survival of three, twenty-seven, and four months, respectively. Of these patients, one did not receive treatment and one refused treatment. On the other hand, six patients received immunotherapy, five underwent surgery, two received radiotherapy, and three received simply supportive care. Furthermore, GM therapy was not mentioned in three cases. The results of the included studies on malignant melanoma are summarized in Table 4.

.[103–121]

Endoscopic Findings

In malignant melanoma, it is common to find that the mucosa presents with brownish or black flat or elevated areas or lesions [4, 5]. However, amelanotic melanoma metastases are usually unpigmented, and amelanotic metastases of primary melanotic melanoma have been described in the stomach [1].

Urogenital metastasis

Of the 20 patients with kidney cancer, nine were female and 11 were male; the median age was 68.5. Metastases other than GM were observed in 11 patients. Four instances had an overall survival rate of two months to one year which was noted. Nine gastrectomies, four endoscopic mucosal resections, four chemotherapy sessions, and one radiotherapy session were performed in 20 patients, leaving one patient without any form of treatment for GM. The median age of the patients with prostate cancer was 67 years. Three patients underwent mucosal resection, four received chemotherapy, and one patient declined GM treatment. Three patients, whose durations ranged from four to 19 months, had overall survival reports. In addition to receiving chemotherapy, two of the four patients with testicular cancer also had additional metastases. The patient in one trial was referred for palliative care and had bladder cancer without further metastases. A summary of the data on stomach metastases from primary urogenital malignancies is presented in Table 5.[71, 122–151]

Additional malignancy

The Median age of the four individuals with Merkel cell cancer. Together with GM, two patients also had additional metastases. One patient received chemotherapy and radiotherapy, whereas the other three patients received surgery, chemotherapy, and radiation therapy. Chemotherapy and radiation therapy were administered to a patient with squamous cell carcinoma who also had metastases other than GM. Although breast metastasis from an extramammary neoplasm is rare, accounting for only 0.5–2.0% of all mammary malignancies, primary breast cancer is a common malignancy in females and continues to be the leading cause of cancer-associated mortalities among females worldwide (1). Malignant melanoma, lymphoma, lung cancer, ovarian carcinoma, and soft tissue sarcoma are the most frequent causes of breast metastases. Gastrointestinal and genitourinary tumor types are next in line [3–6]. Breast metastasis to the stomach is rare; however, there are detectable cases of gastric metastasis to the breast.

Data gathering: One of the inclusion criteria was the histological diagnosis of stomach metastases from breast cancer. Studies in databases from January 1960 to December 2016, such as PubMed, MEDLINE, Embase, Google Scholar, Wanfang Database, China Science, Technology Periodical Database, and China Journal Net, were evaluated using the keywords "gastric or stomach," "tumor or cancer or carcinoma," "breast or mammary," and "metastasis" to obtain data on studies detailing patients with gastric cancer with breast metastasis. All titles, abstracts, and related citations were reviewed and digitized. The following list of pertinent sources provides the data [9, 10, 12, 13, 23–66]. A retrospective assessment was conducted on three patients diagnosed with stomach cancer and breast metastases at Renji Hospital between January 2003 and December 2017. With a median age of 49.00 ± 1.73 years (range: 48–51 years), all patients were female. Of these patients, one was diagnosed with both stomach cancer and breast metastases.

The patient with three bone tumors was the youngest in the group at 14 years of age. One of the patients with known treatment received chemotherapy and surgery for GM therapy, whereas the other patient simply received surgery. GM was identified as metachronous in all the cases. Soft tissue cancer was included in three studies. Radiation, chemotherapy, snare excision, and cautery were among the several forms of GM treatment administered to the three patients, all of whom also had metastases. Median age of patients with thyroid carcinoma. Only one patient's overall survival (OS) (2.5 months) was reported. Patients with GM and primary cancer with diffuse large B-cell lymphoma (DLBCL) (n = 2) underwent treatment. Concurrently, GM has also been discovered. Adrenocortical cancer of the adrenal gland is the only case of GM, and Kovecsi et al.. [152] Along with splenectomy and end-to-side Roux-en-Y esophagojejunal anastomosis for GM, the patient underwent adrenalectomy for primary and total gastrectomy. A patient with retroperitoneal choriocarcinoma underwent chemotherapy for both the primary cancer and GM. The conclusions of the included studies on gastrointestinal malignancies are summarized in Table 6.[150–171].

Based on clinical and autopsy findings, gastric metastases are rare and provide insights into the advanced stages of malignant diseases. The reported incidence ranges from 0.2–0.7%. Moreover, metastases to the stomach often signify a short survival period. Because of clinical issues with their diagnosis and management, these metastases are infrequently observed [2]. As cancer patient prognoses improve, stomach metastatic tumors are becoming increasingly common [1]. Gastric metastases can cause several symptoms including dyspepsia, diarrhea, nausea, vomiting, and abdominal discomfort. The most recommended treatment for stomach metastases is tumor excision through surgery. Chemotherapy is the most commonly used alternative treatment.

It is necessary to note a few possible shortcomings in this systematic review. This variability was unavoidable because 172 case reports from various journals were selected for inclusion in the systematic review. Certain articles omitted crucial details such as comprehensive follow-up and clinical data. Furthermore, it was not possible to evaluate the quality or bias of the papers because each of the included publications was a case report.

Gynacological Malignancy

Breast cancer is the leading cause of gastric metastasis. Metastases in the uterus and ovaries are noticeably less common [37]. In the digestive tract, invasive lobular carcinoma has the highest affinity, with an incidence of 4.5% compared to 0.2% for ductal cancer [26]. GIT metastases from breast cancer are uncommon; the median duration between the initial tumor diagnosis and metastasis can reach seven years [21].

Twenty-two years have passed since the initial diagnosis (17 of 24). This is the longest disease-free interval [10]. Certain metastatic tumors may present similarly to the initial gastric cancer.[37]. The most precise diagnosis to distinguish between primary gastric cancer and gastric metastases from breast cancer is made possible by comprehensive immunohistochemical analysis [26].

The majority of gastric metastatic breast tumors are negative for the human epidermal growth factor receptor (HER2), positive for the estrogen receptor (ER), and positive or negative for the progesterone receptor (PR). Nonetheless, 20–28% of patients with primary gastric cancer show positive ER and PR expression [19]. A diagnosis of metastatic breast cancer cannot be established based only on these two tests because in many situations, the disease is negative for both ER and PR [49]. Although they can be employed as markers, ER and PR are not always appropriate diagnostic markers for determining the origin of a tumor [11]. The literature regularly addresses the management of gastrointestinal metastases from breast cancer. First, systemic therapy was used [37]. Approximately 46% of the patients respond well to systemic therapy. Palliative care may involve surgical intervention [33]. Surgery should be considered when bleeding or obstruction, surgery may be considered [36]. It is crucial to consider the likelihood that breast cancer may metastasize to the gastrointestinal tract because it can be the initial manifestation of the disease [26.46].

Gastrointestinal tract malignancy

Gastrointestinal malignancies comprise a small percentage of cancers that spread to the stomach. Anemia, bleeding, and pain are non-specific symptoms associated with gastric metastases. Most primary malignancies are found in the liver, colon, or pancreas. In addition to stomach metastases, nine individuals also had additional metastases. Pancreatic malignancies rarely respond well to treatment because they are typically discovered at an advanced stage, which makes surgical intervention unlikely. Within a year, three of five patients passed away [2, 6, 8]. Pancreatic head malignancies had a worse prognosis among these instances compared to body and tail cancers.

pulmonary cancer

Lung cancer is the deadliest type of cancer worldwide. However, compared to the brain, liver, adrenal glands, and bones, the stomach is not a common location for metastases from original lung malignancies. 74% However, it has been discovered that the expected longevity following metastasis diagnosis is not very high. Out of the 16 instances that ended in death, the median survival time was four months (average 6.8 months). However, research has indicated that endoscopy is the gold standard for diagnosis. Furthermore, pathology and immunohistochemistry are thought to play a significant role in distinguishing stomach metastases from original tumors [80]. While non-invasive chemotherapy treatments were the most popular option for treating gastric metastases of pulmonary origin, patients who underwent surgery, most notably partial gastrectomy, but also esophagogastrostomy and laparotomy, tended to have comparatively longer survival times [90, 95, 77]. However, this result is not conclusive, as there are situations in which patients may not need surgery if their illness is really serious, and there are few examples where surgical treatments have been used. Therefore, more research is required to determine whether these procedures can extend a patient's predicted lifespan.

Adverse melanoma

Melanoma is responsible for approximately 75% of skin cancer-related deaths, but accounts for only 5% of cutaneous malignancies [103, 107]. The most frequent gastrointestinal (GI) tract metastatic tumor is malignant melanoma [110, 120, 103]. An initial cutaneous melanoma typically requires 52 months to migrate to the gastrointestinal system [110, 107]. Merely 1–4 percent of individuals with malignant melanoma pass away before the diagnosis of gastrointestinal metastases. Conversely, autopsies revealed that > 60% of melanoma patients had GI tract metastases [110, 111, 114, 121]. The rectum and small and large bowels are the most frequently affected areas; stomach metastasis is an uncommon occurrence [110, 111, 117, 119, 121] because its symptoms, which include weight loss, hematemesis, vomiting, nausea, and epigastric discomfort, are non-specific [103, 107, 110, 111, 114, 117, 121]. Four to six months is The typical survival time [107, 121, 103 ]. Pigmentation-induced melanoma metastases can be successfully identified using endoscopy and subsequently verified using histology and immunohistochemistry [114, 121]. Immunotherapy, chemotherapy, targeted therapy, and surgical excision are some of the available treatment options. Surgical excision can be a palliative procedure that extends the survival of patients exhibiting symptoms [121, 103].

Urogenital malignancy

GM is rare in cases of urogenital metastases, with documented incidences ranging from 0.2–0.7%. [123]. Anemia, malaise, and gastrointestinal bleeding (melena and hematemesis) are the most common clinical manifestations. In contrast, two patients did not exhibit any gastrointestinal problems [131, 140]. Esophagogastroduodenoscopy is frequently required for localized therapy and diagnosis. [131]. Gastric metastases are considered a significant sign of advanced illness [149]. Depending on the metastatic stage, many treatment options are available, including chemotherapy, endoscopic resection, partial or total gastrectomy, and palliative care. Even though patients who underwent surgery appeared to have longer overall survival rates, this could primarily be attributed to the fact that these individuals had early stage illnesses that could benefit from surgery. Consequently, the patient's overall health and disease stage should be considered when choosing a course of treatment.

Meleena, vomiting, anemia, exhaustion, loss of appetite, and stomach pain ranked the most among the symptoms in terms of frequency. If GM is suspected, gastrointestinal endoscopy is crucial for the diagnosis [162]. In two cases, tumor seeding was noted upon endoscopic gastrostomy tube replacement. [161, 169]. Although surgery is often used to treat solid organ cancer metastases, chemotherapy is the preferred treatment for DLBCL, skin cancer, and sarcomas. There were only four cases where overall survival was given; therefore, it is impossible to determine which treatment approach is better. Stomach metastases are not commonly reported. Thus, it appears that clinicians have difficulty making decisions regarding prognosis and treatment planning based on scientific facts.

It is uncommon for gastric metastases to manifest, and the exact mechanisms underlying metastatic stomach illnesses remain unknown. Gastric metastatic disease typically indicates a late-stage malignant disease. Chemotherapy is the primary treatment for stomach metastases and is the driving force behind most cases. The original tumor site dictates prognosis. The endoscopic appearance varies and the clinical presentation is nonspecific. Therefore, stomach metastases require careful workup and consideration as a differential diagnosis for gastric lesions.

Resection surgery was the most common form of treatment among the 172 case reports analyzed; it was occasionally paired with immunotherapy and chemotherapy. However, there is a dearth of information in the literature regarding the treatment of patients with secondary stomach cancers. Consequently, further multicenter research is required to determine the optimal course of treatment for patients with stomach metastasis.

Acknowledgment is not applicable

Declaration and ethical clearance

Ethical clearance was obtained from Zagagic University, Faculty of Medicine, Institutional for Data Collection. This study was conducted in accordance with the Declaration of Helsinki.

Consent for publication is not applicable

Availability of data and materials: a database is available to the corresponding author. This database is available for review and request. All authors have shared the database.

Competing interests

The authors declare they have no competing interests or financial disclosures.

Funding

No specific funds were received for this study

Authors Affilatiion

Hassan A. Saad¹,

Azza Baz²,

Mohamed Riad¹,

Mohamed E Eraky¹,,

Mohamed I Farid¹,

Khaled Sharaf¹

Ahmed El-Taher¹

Ahmed Salah Arafe¹

¹Surgical Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt.

²Surgical Department, Alahrar Teaching Hospital, Zagazig University, Zagazig City, Egypt

³Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig City, Egypt

Corresponding author: Hassan A. Saad, Telephone: (+20) 01221025689, ORCID:0000-0002-6242-7823. E-mail: [email protected]

Author contributions

HAS, ME: contributed to the conception and design of

MR. AKE organised the database and

performed the statistical analysis.

HAS,KS: wrote sections of the manuscript

and prepared tables.

MIF, AB,ASA: contributed to the manuscript.

revision and investigation.

All authors read, approved, and equally shared the submitted version

Authors information

Authors' email and billing addresses

Hassan A. Saad: -1

[email protected]

Zagagic City, Sharquia

12 Saad Zagloul, St. Egypt

Corresponding author

Postcode (PC): 44661

01221025689

Azza Baz-2

[email protected]

Zagagic City, Sharquia, Egypt,

13 Kawmia St.

Post code 55971

01226534689

Mohamed Riad-3

[email protected]

Zagagagic City, Sharquia, Egypt

,13 orbi st

Post code 55971

01277438642

Mohamed E Eraky-4

[email protected]

52 reiad St.

Post code 55971

01019598000

Mohamed I Farid-5

[email protected]

Zagagic City, Sharquia, Egypt,

13 Kawmia St.

Post code 55971

01226534689

Khaled Sharaf-6

[email protected]

Zagagic City, Sharquia, Egypt,

25 Kawmia St.

Post code 55971

01019754434

Ahmed k El-Taher-7

[email protected]

Zagagic City, Sharquia, Egypt,

13 Kawmia St.

Post code 55971

01226534689

Ahmed Salah Arafa-8

[email protected]

Zagagic City, Sharquia, Egypt,

35 Kawmia St.

Post code 55971

01226530967

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Table 1

Data about metastases from gynecologic cancers
First author	No of cases	Age	Sex	Site of primary tumor	Histology type of primary	Treatment of primary	Treatment of metastasis	Clinical presentation of GM
Fousekis et al.²	1	64	F	Breast	Lobular Ca	ChT	ChT	Dysphagia, dyspepsia
Watanabe et al.³	1	71	F	Breast	Ductal Ca	Mastectomy and axillary lymph adenectomy, ChT	Endocrine therapy	Asymptomatic
Husain et al.⁴	1	47	F	Left breast	Ductal Ca	Neoadjuvant ChT, mastectomy with a left axillary lymph adenectomy, adjuvant endocrine therapy	N/S	Dyspepsia, weight loss, vomiting
Zhang et al.⁵	1	46	F	Bilateral breast	Lobular Ca	N/A	N/A	Epigastric discomfort
Jabi et al.⁶	1	60	F	Right breast	Lobular Ca	Palliative ChT	Palliative ChT	Epigastralgia, gastric bleeding, Anemia
Johnson et al.⁷	1	50	F	Breast	Ductal Ca	Lumpectomy, adjuvant RT, ChT	N/S	N/S
Okamoto et al.⁸	1	51	F	Breast	Ductal Ca	ChT	ChT	Melena, presyncope
Nehmeh et al.⁹	1	58	F	Right breast	Ductal Ca	Right modified mastectomy, left prophylactic mastectomy, adjuvant ChT	N/S	Perforated ulcer
Hanafiah et al.¹⁰	1	71	F	Left breast	Lobular Ca	Left mastectomy, axillary clearance, ChT, RT	Ch	Hoarseness, weight loss, early satiety
Teixeira et al.¹¹	1	40	F	Right breast	Lobular Ca	Neoadjuvant ChT, RT, conservative surgery for right breast and right axillary lymph node	Total gastrectomy	Nausea, epigastric discomfort, early satiety, weight loss
Kutasovic et al.¹²	1	52	F	Left breast	Invasive Ca of no special type	Local excision, adjuvant RT, ChT, hormone therapy	Subtotal gastrectomy	N/S
Abdallah et al.¹³	1	53	F	Breast	Lobular Ca	ChT, hormone therapy	N/S	Abdominal pain, diffuse tenderness, abdominal distention
Liu et al.¹⁴	1	82	F	Left breast	Phyllodes tumors	Total mastectomy for recurrent tumor local excision, RT	Excision surgery, RT	Anemia, melena
Tang et al.¹⁵	1	67	F	Left breast	Ductal Ca	Left breast-conserving surgery, axillary lymphadenectomy, adjuvant ChT, RT	N/S	Stomach pain
De Gruttola et al.¹⁶	1	61	F	Breast	Lobular Ca	Mastectomy, adjuvant ChT, RT	Total gastrectomy due to gastric perforation	Gastric perforation
Mohy-Ud-Din et al.¹⁷	1	83	F	Breast	Lobular Ca	Mastectomy, sentinel lymph nodes excision, adj. ChT	N/A	Nausea, vomiting
Güler et al.¹⁸	1	42	F	Breast	Ductal Ca	N/A	Total gastrectomy due to gastric perforation, ChT	Acute Abdomen
Cui et al.¹⁹	1	42	F	Endometrium	Endometrial Aca	Total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy	Neoadjuvant ChT, partial gastrectomy	N/S
Asmar et al.²⁰	1	84	F	Breast	Lobular Ca	Left mastectomy, adjuvant ChT, RT, hormone therapy	Hormone therapy	Dyspepsia
Klair et al.²¹	1	60	F	Ovary	Ovarian granulosa cell tumor	Total hysterectomy, bilateral salpingo-oophorectomy	N/A	Reflux, abdominal pain, nausea, anorexia
Yang²²	1	47	F	Ovary	Ovarian serous cystadenocarcinoma	Total hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, total omentectomy	Laparoscopic resection, adjuvant ChT	Abdominal pain
Bushan et al.²³	1	68	F	Left breast	Lobular Ca	Wide excision of breast lesion, ChT, RT, hormone therapy	Distal gastrectomy with D2 lymphadenectomy, left axillary excision, ChT	Weight loss, dysphagia
Zhang et al.²⁴	2	45	F	Breast	Lobular Aca	Lumpectomy, RT, ChT	N/S	N/S
Zhang et al.²⁴	2	64	F	Breast	Lobular Aca	N/A	N/A	Weight loss
Jin et al.²⁵	1	55	F	Breast	Lobular Ca	Neoadjuvant ChT, radical mastectomy, ChT, RT	ChT	N/S
Buka et al.²⁶	1	58	F	Breast	Invasive lobular Ca	ChT, hormone therapy, RT	Neoadjuvant ChRT, total gastrectomy, adjuvant ChT	Abdominal pain, weight loss
Dória et al.²⁷	1	66	F	Breast	Invasive lobular Ca	Letrozole	Total gastrectomy, lymphadenectomy, esophagojejunostomy with a Roux loop technique	Epigastric pain, vomiting, weight loss
Hwangbo et al.²⁸	1	73	F	Ovary	Serous Aca	Cytoreductive surgery, adjuvant ChT	Distal gastrectomy with Billroth I anastomosis, lymphadenectomy	Epigastric pain, dyspepsia
Shetty et al.²⁹	2	56	F	Breast	Invasive ductal Ca	Breast conservation therapy, adjuvant ChT	ChT	Epigastric discomfort, non-bilious vomiting
Shetty et al.²⁹	2	61	F	Breast	Invasive ductal Ca	Left breast modified radical mastectomy, adjuvant RT	Palliative ChT	Abdominal pain, melena, abdominal distension
Geredeli et al.³⁰	1	47	F	Breast	Invasive lobular Ca	Palliative ChT	Subtotal stomach resection, ChT	Asymptomatic
Kim et al.³¹	1	58	F	Ovary	Serous Aca	Total hysterectomy with salpingo-oophorectomy, lymphadenectomy with total omentectomy, adjuvant ChT	Subtotal gastrectomy, lymphadenectomy, ChT	Asymptomatic
Fernandes et al.³²	1	51	F	Breast	Invasive lobular Ca	Quadrantectomy, adjuvant ChT, adjuvant RT, hormone therapy	Total gastrectomy, adjuvant ChT, hormone therapy	Dyspepsia
Moldovan et al.³³	1	49	F	Cervix uteri	SCC	Surgery, ChRT	Subtotal gastrectomy, lymphadenectomy D2, anastomotic layout shaped as Y Roux, omentectomy, adjuvant ChRT	Pyloric stenosis, epigastric pains, late postprandial emesis, weight loss
Zhou and Miao³⁴	1	61	F	Ovary	Serous Aca	Optimal debulking cytoreductive surgery, adjuvant ChT	Gastric antrectomy	Asymptomatic
Critchley et al.³⁵	1	62	F	Breast	Invasive lobular Ca	Mastectomy, level 2 axillary clearance, adjuvant ChT, adjuvant RT, adjuvant hormone therapy	ChT	Loose stool, normocytic anemia, weight loss
Hara et al.³⁶	1	74	F	Breast	Invasive ductal Ca	Breast-conserving surgery	Paclitaxel	Chronic gastritis
Ciulla et al.³⁷	1	70	F	Breast	Lobular Ca	Postoperative hormone therapy	Total gastrectomy, lymphadenectomy R1, esophagojejunostomy with Roux loose technique	Asymptomatic
Jones et al.³⁸	2	51	F	Breast	Lobular Ca	Wide local excision, axillary dissection, adjuvant RT	Total gastrectomy with Roux-en-Y reconstruction, hormone therapy	Weight loss, epigastric pain
Jones et al.³⁸	2	61	F	Breast	Lobular Ca	Mastectomy, axillary dissection, adjuvant ChT, RT, tamoxifen	ChT, RT	Progressive dysphagia, weight loss
Yim et al.³⁹	1	48	F	Breast	SRCC	ChT	ChT	Epigastric discomfort
Wong et al.⁴⁰	1	72	F	Breast	Invasive lobular Ca	Wide local excision, adjuvant RT	Hormone therapy	Acute abdomen, rebound tenderness, generalized peritonitis
Ricciuti et al.⁴¹	1	65	M	Breast	Invasive ductal Ca	Total mastectomy, complete axillary dissection, adjuvant hormone therapy	Gastrectomy with Roux-en-Y esophagojejunostomy anastomosis	Hematemesis, epigastric pain
Fernandes et al.⁴²	4	56 (the mean age)	F	Breast	Invasive lobular Ca	ChT, hormone therapy	Total gastrectomy	Ulcerated lesion, major bleeding
		56 (the mean age)	F	Breast	Invasive lobular Ca	ChT, RT, hormone therapy	ChRT	Diffuse infiltration
		56 (the mean age)	F	Breast	Invasive ductal Ca	ChT, hormone therapy	ChT	Infiltrative, ulcerated, stenotic lesion
		56 (the mean age)	F	Breast	Invasive ductal Ca	ChT, hormone therapy	ChRT	Flat erosive lesion
Zullo et al.⁴³	3	49	F	Ovary	Serous Aca	Hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, adjuvant ChT	ChT	Abdominal pain, vomiting, weight loss
		80	F	Cervix uteri	Leiomyosarcoma	Total hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, adjuvant ChT	N/A	Epigastric pain
		70	F	Breast	N/A	Radical left mastectomy, adjuvant ChT	ChT	Dysphagia, epigastric pain
Villa Guzman et al.⁴⁴	1	58	F	Breast	Invasive lobular Ca	Quadrantectomy, lymphadenectomy, adjuvant ChT, RT	ChT, hormone therapy	Nausea, epigastric pain
Mizuguchi et al.⁴⁵	1	71	F	Ovary	Serous Aca	Total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, ChT	ChT, hormone therapy	Asymptomatic
Jmour et al.⁴⁶	4	51	F	Breast	Mixed	Radical mastectomy with lymphadenectomy	ChT, RT	Nausea, vomiting, abdominal pain
		47	F	Breast	Lobular infiltrating Ca	Radical mastectomy with lymphadenectomy	ChT, RT	Nausea, vomiting, abdominal pain
		51	F	Breast	Ductal infiltrating Ca	N/A	ChT, RT	Nausea, vomiting, abdominal pain
		36	F	Breast	Lobular infiltrating Ca	Radical mastectomy with lymphadenectomy	ChT, RT	Nausea, vomiting, abdominal pain
Yim⁴⁷	1	65	F	Breast	Invasive lobular Ca	Modified radical mastectomy, adjuvant ChT, adjuvant RT	ChT	Dyspepsia, anorexia, indigestion, epigastric discomfort, early satiety, weight loss
Choi et al.⁴⁸	1	44	F	Breast	Phyllodes tumor	Right lumpectomy, axillary lymphadenectomy, RT, right total mastectomy	Endoscopic hemostasis with cauterization	Dizziness, anemia, melena
Khan et al.⁴⁹	1	56	F	Breast	Signet ring Aca	ChT	ChT	Anemia
Mullally et al.⁵⁰	1	46	F	Breast	Invasive ductal Ca	Left mastectomy, adjuvant ChT, hormone therapy, RT	Palliative laparoscopic gastroduodenostomy, hormone therapy, palliative ChT	Epigastric and left shoulder pain, epigastric tenderness, upper abdominal rigidity
Kliiger and Gorbaty⁵¹	1	60	F	Breast	Invasive ductal Aca	Systemic therapy, ChT	N/A	Nausea, diarrhea, vomiting, weight loss
Antonini et al.⁵²	1	61	F	Ovary	Serous Ca	ChT, cytoreductive surgery	ChT	Dyspepsia
Kono et al.⁵³	1	64	F	Ovary	Mucinous Ca	Bilateral salpingo-oophorectomy, simple hysterectomy, pelvic and para-aortic lymphadenectomy, partial omental resection	ChT	Back pain
Kim et al.⁵⁴	1	39	F	Breast	Invasive lobular Ca	Right breast-conserving surgery, lymphadenectomy	Duodenal stent, systemic ChT	Upper abdominal discomfort and pain, indigestion
Woo et al.⁵⁵	1	51	F	Breast	Invasive lobular Ca	Bilateral modified radical mastectomy, ChT, RT	Radical subtotal gastrectomy with Billroth II anastomosis, D2 lymphadenectomy, ChT	Epigastric pain
Ulmer et al.⁵⁶	1	55	F	Breast	Invasive lobular Ca	Bilateral mastectomy, adjuvant ChT, RT, hormone therapy	Palliative pyloric stent	Nausea, vomiting, early satiety, weight loss

Table 2

Data illustrating the metastasis of gastrointestinal malignancies
First author	No of cases	Age	Sex	Site of primary tumor	Histology type of primary	Treatment of primary	Treatment of metastasis	Clinical presentation of GM
Iwai et al.⁵⁷	1	76	F	Transverse colon	Poorly differentiated Aca with a partial component of signet-ring Ca	ChT	ChT	Anemia, anorexia
Yang et al.⁵⁸	1	74	F	Head of pancreas	Poorly differentiated invasive Aca	ChT	ChT	RUQ pain
Lee and Lee⁵⁹	1	82	M	Right colon	Moderately differentiated Aca	Extended right hemicolectomy (declined adjuvant ChT)	Radical total gastrectomy (declined adjuvant ChT) with Roux-en-Y and D2 dissection	Asymptomatic
Rothermel et al.⁶⁰	1	61	M	Body of pancreas	Well-differentiated ductal Aca	Distal pancreatectomy, splenectomy, adjuvant ChT	ChT, palliative radiation, and wedge gastrectomy	Asymptomatic
Terashima et al.⁶¹	1	61	F	Transverse colon	Poorly differentiated Aca	Extended right hemicolectomy, ChT	Partial gastrectomy and D3 dissection, ChT	Diarrhea, vomiting
Sasajima et al.⁶²	1	72	M	Head and tail of pancreas	IPMN	ChT	ChT (terminated after 2 courses)	N/A
Tomonari et al.⁶³	1	78	M	Body and distal pancreas	Moderately differentiated ACa T3N0M0	Surgery, adjuvant ChT	Subtotal gastrectomy	Follow-up
Adachi⁶⁴	1	67	F	Pancreas	Well-differentiated SCC	Distal pancreatectomy and splenectomy	Total gastrectomy	Anorexia, back pain
Nakazawa et al.⁶⁵	1	59	M	Esophagus	Mucosal SCC	Subtotal esophagectomy, left lateral segmentectomy of liver, pancreatosplenectomy, adjuvant ChT	Proximal gastrectomy	Asymptomatic
Abouzied et al.⁶⁶	1	69	M	Liver	HCC	Right hepatectomy	ChT	Iron-deficiency anemia
Ito et al.⁶⁷	1	78	M	Liver	ICC	Lateral hepatectomy	Proximal gastrectomy and lymphadenectomy	Fatigue
Imai et al.⁶⁸	1	62	M	Liver	HCC	N/A	Transcatheter left gastric artery embolization	Abdominal mass
Kim et al.⁶⁹	1	75	M	Liver	HCC	Right hemihepatectomy, TACE	Gastric wedge resection	Melena, mild dyspnea
Peng et al.⁷⁰	1	22	M	Liver	HCC	Right hemihepatectomy combined with left lateral tumor local resection, cholecystectomy, splenectomy	Gastric tumor local resection	Anemia, FOBT 4+
Kanthan et al.⁷¹	1	85	M	Colon	Aca	N/A	N/A	Anemia
Wang et al.⁷²	1	63	F	Gallbladder	Melanoma	Surgery, ChT	ChT	Postprandial nausea, vomiting

Table 3

Illustrative statistics about lung cancer metastases
First author	No of cases	Age	Sex	Site of primary tumor	Histology type of primary	Treatment of primary	Treatment of metastasis	Clinical presentation of GM
Catalano et al.⁷³	1	78	M	Lung - right upper lobe	Poorly differentiated Aca	Upper right lobectomy	Total gastrectomy	Asymptomatic
Shih-Chun et al.⁷⁴	1	55	M	Lung - right upper lobe	NSCLC	Concurrent chemoradiotherapy	Palliative total gastrectomy, ChT	Gastric bleeding, ulcerative mass
Das Majumdar et al.⁷⁵	1	72	M	Lung	Poorly differentiated Aca	Palliative RT	Immunotherapy, ChT	Identified with body CT after pathological fracture
Liu et al.⁷⁶	1	58	M	Lung	Aca	Middle right lobectomy, neoadjuvant therapy, ChT	ChT, partial gastrectomy	N/S
Nemoto et al.⁷⁷	1	64	M	Lung - right lower lobe	SCC	Adjuvant ChT	Esophagogastrostomy	Epigastric pain, progressive dysphagia
He et al.⁷⁸	1	61	M	Lung	SCLC	Left lower lobectomy	Cardia resection	Progressive dysphagia
Yang et al.⁷⁹	1	59	M	Lung - left upper lobe	Poorly differentiated metastatic carcinoma	ChT	Anti-PD1 immunotherapy	Right upper limb pain, epigastric discomfort
Li et al.⁸⁰	1	61	M	Lung - right lower lobe	SCC	ChT	ChT, gastrectomy	Progressive abdominal distention
Bhardwaj et al.⁸¹	1	39	F	Lung	SCC	ChT, nivolumab	RT	Dizziness, melena
Badipatla et al.⁸²	1	65	M	Lung	Aca	ChT, palliative care	ChT, palliative care	Bilateral flank pain, nausea, vomiting, change in bowel habit
Qasrawi et al.⁸³	1	69	F	Lung - left upper lobe	Aca	RT	Hospice care	Melena, hypotension
Kim et al.⁸⁴	1	70	F	Lung	Pleomorphic carcinoma	Right bronchial artery embolization, right upper lobectomy, adjuvant ChT	Partial gastrectomy, immunotherapy	Abdominal pain
Maeda et al.⁸⁵	1	60	F	Lung	SCLC	ChT	N/A	Nausea, vomiting
Struyf et al.⁸⁶	1	68	M	Lung	Aca	ChT	ChT	Severe epigastric pain
Altintas et al.⁸⁷	1	55	M	Lung	Aca	ChT	ChT	Epigastric pain, hematemesis, melena
Casella et al.⁸⁸	1	63	M	Lung	SCLC	Supportive care	Supportive care	Fever, weight loss, epigastric pain, constipation
Ohashi et al.⁸⁹	1	62	M	Lung	Large cell carcinoma	Right upper lobectomy	ChT	Abdominal pain
Aokage et al.⁹⁰	2	69	M	Lung - right upper lobe	Pleomorphic carcinoma	Right upper lobectomy, parietal pleura resection	Partial gastrectomy, splenectomy	Fatigue, anemia
Aokage et al.⁹⁰	2	62	M	Lung - left upper lobe	Pleomorphic carcinoma	Left upper lobectomy	Distal gastrectomy, splenectomy	N/A
Katsenos and Archondakis⁹¹	1	61	M	Lung - left upper lobe	Aca	ChT	ChT	Upper GIS bleeding
Diem et al.⁹²	1	62	F	Lung - right upper lobe	Aca	N/A	ChT	Epigastric pain
Hu et al.⁹³	1	54	M	Lung	SCC	RT, right middle lobectomy	None (patient refused)	Dysphagia
Koh et al.⁹⁴	1	46	M	Lung	Pleomorphic carcinoma	Antibiotics	N/A	Abdominal pain, tenderness
Hung et al.⁹⁵	1	47	M	Lung	SCC	RT, ChT	ChT	Weight loss, dysphagia
Taira et al.⁹⁶	1	64	M	Lung	Pleomorphic carcinoma, Aca	Left upper lobectomy	ChT	Anemia
Gao et al.⁹⁷	1	66	M	Lung	SCLC	ChT	ChT, supportive care	Epigastric pain
Kim et al.⁹⁸	1	68	M	Lung	Poorly differentiated Aca	Left lower lobectomy, posterior segmentectomy right upper lobe (2004), left upper lobe wedge resection (2007), palliative chemotherapy	Palliative ChT	Epigastric pain, dyspepsia
Chen et al.⁹⁹	1	59	F	Lung	Sarcomatoid carcinoma	Supportive treatment	Supportive treatment	Abdominal pain, anorexia, weight loss
Dong et al.¹⁰⁰	1	60	F	Lung	Glomus tumor	N/A	N/A	Hemoptysis, melena, abdominal distension
Kim et al.¹⁰¹	2	66	M	Lung	SCLC	N/A	N/A	Epigastric pain, epigastric tenderness, fatigue
Kim et al.¹⁰¹	2	68	M	Lung	SCLC	N/A	N/A	Hemoptysis, weight loss
Del Rosario et al.¹⁰²	1	77	F	Lung	Aca	ChT	Palliative care	N/A
Kanthan et al.⁷¹	1	75	M	Lung	Aca	N/A	N/A	Epigastric pain, RUQ pain

Table 4

Data that demonstrate the spread of malignant melanoma
First author	No of cases	Age	Sex	Site of primary tumor	Histology type of primary	Treatment of primary	Treatment of metastasis	Clinical presentation of GM
Zhu et al.¹⁰³	1	36	M	Right plantar	Nodular	Mohs microsurgery	N/A	Anorexia, nausea, vomiting
Yoshimoto et al.¹⁰⁴	1	82	F	Fourth left toe	Acral lentiginous	Surgery	Palliative RT	Melena
Okamoto et al.¹⁰⁵	1	79	M	Esophagus	Pigmented submucosal tumor-like growth in the esophagus	Nivolumab	Nivolumab	Gross hematuria, weight loss, cough, exertional dyspnea
Cortellini et al.¹⁰⁶	1	81	M	N/A	N/A	N/A	N/A	Weakness, hyporexia, anemia
Groudan et al.¹⁰⁷	1	66	F	Vulva	N/A	N/A	Palliative RT, immunotherapy	Fatigue, exertional dyspnea, hematemesis, weight loss, nausea
Syed et al.¹⁰⁸	1	49	F	Back	N/A	Surgery	Immunotherapy, supportive care, SRS	Anorexia, abdominal pain, fatigue, weight loss, nausea, vomiting
Genova et al.¹⁰⁹	1	80	M	Scalp	Lentigo	RT	Immunotherapy	Hypochromic anemia
Wong et al.¹¹⁰	1	81	F	Foot	Acral lentiginous	Amputation, CT	Denied the treatment	Dyspnea, fatigue, anemia
Grander et al.¹¹¹	1	67	M	Right hypochondrium, back, scalp	Superficial spreading	Surgery	Total gastrectomy, radiosurgery	Melena
Carcelain et al.¹¹²	1	65	F	N/A	N/A	Surgery	Surgery	N/S
Lestre et al.¹¹³	1	67	M	Lower back	Superficial spreading	Excision, adjuvant immunotherapy	No	N/S
Rana et al.¹¹⁴	1	72	M	N/A	N/A	N/A	N/A	Weight loss, anorexia
Rovere et al.¹¹⁵	1	68	M	N/A	N/A	N/A	Supportive care	N/S
Eivazi-Ziaei et al.¹¹⁶	1	56	M	Right heel-ALM	N/A	Surgery	Supportive care	Epigastric pain
El-Sourani et al.¹¹⁷	1	43	F	Right breast	N/A	Surgery	Sleeve gastrectomy after atypical resection, complete locoregional lymphadenectomy	Melena, anemia
Buissin et al.¹¹⁸	1	63	M	Anorectal	Hyperplastic polyp	Abdominoperineal resection	Supportive care	Tenderness in the RUQ
Bankar et al.¹¹⁹	1	41	F	N/A	N/A	N/A	Surgery	N/S
Mohan et al.¹²⁰	1	28	M	N/A	N/A	N/A	Temozolomide	Abdominal pain, anorexia, weight loss
Farshad et al.¹²¹	1	89	M	Chest wall	N/A	Local excision	Nivolumab	Fatigue, rigors, fever

Table 5

Data illustrating urogenital carcinoma metastases
First author	No of cases	Age	Sex	Site of primary tumor	Histology type of primary	Treatment of primary	Treatment of metastasis	Clinical presentation of GM
Tapasak and Mcguirt¹²²	1	77	M	Kidney	RCC	Nephrectomy, ChT	Roux-en-Y gastric bypass	Gastrointestinal bleeding, anemia
Podzolkov et al.¹²³	1	30	M	Testis	Choriocarcinoma	ChT	N/A	Epigastric pain, dyspnea
Koterazawa et al.¹²⁴	1	70	F	Kidney	RCC	Nephrectomy	Endoscopic submucosal resection	Weight loss
Hakim et al.¹²⁵	1	86	F	Kidney	RCC	Nephrectomy, ChT	RT	Gastrointestinal bleeding
Yoshida et al.¹²⁶	1	85	F	Kidney	RCC	Nephrectomy	Endoscopic resection	Anemia, melena
Bernshteyn et al.¹²⁷	1	68	M	Kidney	RCC	Nephrectomy	N/A	Dyspnea, melena
Weissman et al.¹²⁸	2	70	M	Kidney	RCC	Nephrectomy	ChT	Dyspepsia, malaise, weight loss
Weissman et al.¹²⁸	2	85	M	Kidney	RCC	Nephrectomy	ChT	Dyspepsia, malaise, weight loss
Chaar et al.¹²⁹	1	30	M	Testis	Choriocarcinoma	Orchiectomy	ChT (patient refused)	Melena, anemia
Arakawa et al.¹³⁰	1	80	F	Kidney	RCC	Cht	ChT	Anorexia, pyrexia, malaise
Uehara et al.¹³¹	1	73	M	Kidney	RCC	Nephrectomy, ChT	Endoscopic mucosal resection, immunotherapy	Gastric mass
O'Reilly et al.¹³²	1	59	F	Kidney	Clear cell RCC	Nephrectomy	Laparoscopic sleeve gastrectomy	Asymptomatic
Abu Ghanimeh et al.¹³³	1	67	M	Kidney	Clear cell RCC	Nephrectomy	No treatment initiated	Gastrointestinal bleeding
Mazumdar et al.¹³⁴	1	49	M	Testis	Seminoma	N/A	N/A	Abdominal pain
Barras et al.¹³⁵	1	53	M	Kidney	RCC	Nephrectomy	Partial gastrectomy	Hematochezia
Riviello et al.¹³⁶	1	68	M	Kidney	RCC	Nephrectomy	Gastrectomy, ChT	Melena, postural dizziness, weakness
Hong et al.¹³⁷	1	60	M	Bladder	Clear cell urothelial Ca	ChT, RT	Palliative care	Projectile vomiting
Onitilo et al.¹³⁸	2	57	M	Prostate	Aca	LHRH agonist	ChT	Weakness, nausea, vomiting, hematemesis
Onitilo et al.¹³⁸	2	89	M	Prostate	Aca	LHRH agonist	ChT	Weakness, nausea, vomiting, hematemesis
Tiwari et al.¹³⁹	1	58	F	Kidney	Clear cell RCC	N/A	Roux-en-Y subtotal gastrectomy	Melena, hematemesis, fatigue
Yodonawa et al.¹⁴⁰	1	73	M	Kidney	Leiomyosarcoma	Nephrectomy	Distal gastrectomy	Melena, weakness
Chibbar et al.¹⁴¹	1	69	F	Kidney	Clear cell RCC	Nephrectomy	Endoscopic mucosal resection	Fatigue, lightheadedness, anemia
Sakurai et al.¹⁴²	1	61	M	Kidney	RCC	Nephrectomy	Partial gastrectomy, ChT	Melena, anemia
Patel et al.¹⁴³	1	71	M	Prostate	Aca	Surgery, RT	N/A	Weakness, dizziness, anemia
Sharifi et al.¹⁴⁴	1	17	F	Kidney	Primitive neuroectodermal	ChT	ChT	Abdominal pain, distention
Greenwald et al.¹⁴⁵	1	62	M	Kidney	Clear cell RCC	Nephrectomy	Partial gastrectomy	Testicular pain
Costa et al.¹⁴⁶	1	66	F	Kidney	RCC	Nephrectomy	Palliative laparoscopic wedge resection	Anemia
Soe et al.¹⁴⁷	1	64	M	Prostate	N/A	LHRH agonist	Palliative care (patient refused chemotherapy)	Anemia, melena
Bhandari and Pant¹⁴⁸	1	58	M	Prostate	Aca	LHRH agonist	ChT	Abdominal pain
Lowe et al.¹⁴⁹	1	18	M	Testis	Choriocarcinoma	ChT, orchidectomy	ChT	Melena, lethargy, dizziness
Inagaki et al.¹⁵⁰	1	75	M	Prostate	Aca	LHRH agonist	Endoscopic mucosal resection, hormone therapy	Epigastric pain
Tavukcu et al.¹⁵¹	1	67	M	Prostate	Mixed 55% ductal 45% acinar	Prostatectomy, RT	Androgen deprivation therapy, ChT	Ascites, vomit
Kanthan et al.⁷¹	1	19	M	Testis	Predominantly choriocarcinoma, embryonal Ca	Orchiectomy	Partial gastrectomy聽	Melena, anemia

Table 6

Slhows data illustrating the metastasis of other malignancies.
First author	No of cases	Age	Sex	Site of primary tumor	Histology type of primary	Treatment of primary	Treatment of Metastasis	Clinical presentation of GM
Kovecsi et al.¹⁵²	1	71	M	Adrenal gland	Adrenocortical carcinoma	Right adrenalectomy	Total gastrectomy, splenectomy, with end-to-side Roux-en-Y eso-jejunal anastomosis	Weight loss, epigastric pain, vomiting, fatigue
Koti et al.¹⁵³	1	14	F	Bone	Ewing sarcoma	ChT, local excision	ChT, total gastrectomy, RT	Abdominal mass, low-grade fever, weight loss
Dodis et al.¹⁵⁴	1	72	F	Bone	Ewing sarcoma	Total knee replacements, RT, ChT	N/A	Anemia
Urakawa et al.¹⁵⁵	1	73	M	Bone	Osteosarcoma	ChT, surgery	Partial gastrectomy	Anemia, hematemesis
Shibuya et al.¹⁵⁶	1	27	M	Extragonadal retroperitoneal	Choriocarcinoma	Cht	ChT	Abdominal pain, melena, vomiting
Tarangelo et al.¹⁵⁷	1	65	M	Head, neck	SCC	Cht, RT, robotic excision	N/A	Melenic bowel movements
Kamihara et al.¹⁵⁸	1	70	M	Lymph nodes	DLBC	R-CHOP ChT	R-CHOP ChT	N/A
Zepeda-Gomez et al.¹⁵⁹	1	39	F	Lymph nodes	DLBC	ChT, omeprazole	ChT	Melena, weight loss, retroperitoneal mass
Teh et al.¹⁶⁰	1	37	F	Oropharynx	SCC	Surgery, adjuvant RT	Palliative RT	Weight loss, LUQ pain, melena
Elkafrawy et al.¹⁶¹	1	67	M	Skin	MCC	Surgery, consolidative	Atezolizumab, RT	Melena
Ha et al.¹⁶²	1	82	M	Skin	MCC	Surgery, RT	No	Anorexia, weight loss
Idowu et al.¹⁶³	1	79	F	Skin	MCC	Surgery, ChT, RT	N/A	Anemia
Parikh et al.¹⁶⁴	1	60	M	Skin	MCC	ChT, RT	ChT	Maroon colored stools
Subramanian et al.¹⁶⁵	1	62	M	Soft tissue	Leiomyosarcoma	Surgery, RT	RT, ChT	Melena, abdominal pain, nausea, vomiting
Dent et al.¹⁶⁶	1	60	M	Soft tissue	Sarcoma	Surgery	Remove with snare and cautery	Upper abdominal pain, melena
Samuel et al.¹⁶⁷	1	56	M	Soft tissue	Synovial sarcoma	Surgery, RT	Doxorubicin	N/A
Thorburn et al.¹⁶⁸	1	56	M	Supraglottic larynx, hypopharynx	Advanced SCC	Surgery, tracheostomy, radical RT	N/A	Anemia, hematemesis
Fuladi et al.¹⁶⁹	1	71	F	Thyroid	Anaplastic carcinoma	Total thyroidectomy, left modified radical neck dissection, RT	N/A	Nausea, vomiting
Ayaz et al.¹⁷⁰	1	72	M	Thyroid	Anaplastic carcinoma	N/A	N/A	Melena
Karrasch et al.¹⁷¹	1	53	F	Thyroid	Medullary thyroid cancer	Complete thyroidectomy ChT	N/A	Fatigue, anorexia, epigastric pain radiating to the back

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Analysis of stomach metastasis resulting from different cancers in a retrospective review

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