A Case of Metastasis to the Skeletal Muscle after Gastrectomy for Gastric Cancer with Dermatomyositis

Kazuhiro Nishikawa, Yasuhiro Tanaka, Makoto Fujii, Yoshikazu Morimoto, Chu Matsuda, Masashi Hirota and Kazuhiro Iwase*

Department of Surgery, Osaka General Medical Center
Department of Surgery, Rinku General Medical Center, Izumisano Municipal Hospital*

We report an extremely rare case of gastric cancer metastasis to the skeletal muscles associated with dermatomyositis. A 65-year-old man admitted for muscle weakness and anorexia was found on physical examination to have generalized varied redness of the face and upper chest and erythema with desquamation on the dorsum of the hands. Serum CPK was abnormally elevated. Endoscopic examination showed a type 3 tumor in the upper third of the stomach, which we treated with predonisolone followed by total gastrectomy. Histologically, the tumor was poorly differentiated adenocarcinoma classified as Stage IV (pT2 (SS), pN1, pH1, pP0, CY0, pM0) based on the Japanese Classification of Gastric Carcinoma. The patient underwent chemotherapy using TS-1 for seven months postoperatively and serum CEA decreased to within normal values, and his muscular strength improved. He subsequently suffered painful swelling in the right femur and back. Magnetic resonance imaging showed tumors in the vastus lateralis muscle and infraspinatus muscle had ring enhanced intensity in T2-weighted images. Histopathological examination of aspiration needle biopsy specimen from the right vastus lateralis muscle confirmed that tumors had metastasized from gastric cancer. A second round of chemotherapy with paclitaxel was ineffective and the man died 11 months postoperatively due to multiple metastasis to the liver, abdominal lymph nodes, andand peritoneum.

Key words
gastric cancer, dermatomyositis, skeletal muscle metastasis

Reprint requests
Kazuhiro Nishikawa Department of Surgery, Osaka General Medical Center
3-1-56 Banndaihigashi, Sumiyosi-ku, Osaka, 558-8558 JAPAN

Accepted
May 30, 2007

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