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Juxta cortical tibia metastatic deposition in gastric cancer: a case report.
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PMID:  22536265     Owner:  NLM     Status:  PubMed-not-MEDLINE    
We report a 41 years old man with rapidly growing and tender lump on the anteromedial surface of tibia. The patient had the history of gastrectomy and gastrojejunostomy due to gastric carcinoma. On admission, the Simple X-ray of lower extremity disclosed a slight thinning of the anterior cortex of tibia without cortical destruction. The whole-body bone scan with (99m)TC MDP revealed activity of lesion in all 3 phases. The histopathological evaluation showed an infiltration of bone with tumor cells. Review No the literature revealed in previous cases of skeletal metastasis from gastric cancer in the tibia like this.
Majid Sajjadi Saravi; M Hossein Karimi Nasab; Masoud Shayeste Azar; Ghasem Janbabai; Mehrdad Taghipour; S Omid Emadian Saravi; Fariborz Eshghi
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Publication Detail:
Type:  Journal Article     Date:  2012-03-21
Journal Detail:
Title:  Case reports in medicine     Volume:  2012     ISSN:  1687-9635     ISO Abbreviation:  Case Rep Med     Publication Date:  2012  
Date Detail:
Created Date:  2012-04-26     Completed Date:  2012-08-23     Revised Date:  2013-04-15    
Medline Journal Info:
Nlm Unique ID:  101512910     Medline TA:  Case Rep Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  695627     Citation Subset:  -    
Department of Orthopedic Surgery, School of Medicine, Mazandaran University of Medical Sciences, 4813894393 Sari, Iran.
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Journal Information
Journal ID (nlm-ta): Case Report Med
Journal ID (iso-abbrev): Case Report Med
Journal ID (publisher-id): CRIM
ISSN: 1687-9627
ISSN: 1687-9635
Publisher: Hindawi Publishing Corporation
Article Information
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Copyright © 2012 Majid Sajjadi Saravi et al.
Received Day: 21 Month: 8 Year: 2011
Revision Received Day: 14 Month: 11 Year: 2011
Accepted Day: 21 Month: 11 Year: 2011
Print publication date: Year: 2012
Electronic publication date: Day: 21 Month: 3 Year: 2012
Volume: 2012E-location ID: 695627
ID: 3318780
PubMed Id: 22536265
DOI: 10.1155/2012/695627

Juxta Cortical Tibia Metastatic Deposition in Gastric Cancer: A Case Report
Majid Sajjadi Saravi1
M. Hossein Karimi Nasab1
Masoud Shayeste Azar1
Ghasem Janbabai2
Mehrdad Taghipour3*
S. Omid Emadian Saravi4
Fariborz Eshghi5
1Department of Orthopedic Surgery, School of Medicine, Mazandaran University of Medical Sciences, 4813894393 Sari, Iran
2Department of Oncology and Hematology, Cancer Research Center, School of Medicine, Mazandaran University of Medical Sciences, 4813894393 Sari, Iran
3Student Research Committee, Cancer Research Center, School of Medicine, Mazandaran University of Medical Sciences, 4813894393 Sari, Iran
4Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, 4813894393 Sari, Iran
5Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, 4813894393 Sari, Iran
Correspondence: *Mehrdad Taghipour:
[other] Academic Editor: Robert Peter Gale

1. Introduction

Gastric cancer has not been recognized as a number of the group of common bone invaders consisting of lung, prostate, breast, thyroid and kidney cancers [1]. Moreover, metastatic bony lesions tend to occur in axial skeleton or the roots of extremities and their occurrence below elbow or knee is quite rare [2].

2. Case Report

A 41-year-old man came to orthopedic ward with the chief complaint of tender and painful lump on the anteromedial surface of his tibia in the proximal third which had been growing during previous 6 months. The patient was very cachectic and had the history of proximal gastrectomy and gastrojejunostomy which had been done 16 months ago due to gastric carcinoma accompanied with six sessions of chemotherapy and radiotherapy. In pathologic evaluation of the tumor in this operation, moderately differentiated adenocarcinoma with an-epithelial to-serosal extension and no lymph node involvement had been reported. In physical examination of the extremity, a firm and tender lump was seen with a diameter of 6 ∗ 4 cm which was firmly attached to the anteromedial surface of tibia. In simple X-ray an interesting feature was the slight thinning of the anterior cortex without cortical destruction which made the diagnosis of metastatic a bit unlikely (Figure 1(a) and 1(b)). In whole body bone scan with Tc-99 m MDP, the lesion showed activity in all 3 phases and was the only site of skeletal involvement (Figure 2). The patient went through excisional biopsy and the result of microscopic evaluation was metastatic adenocarcinoma (Figure 3(a) and 3(b)). Chest X-ray of patient was normal (Figure 4). But abdominal CT Scan with contrast showed some metastatic lesions in liver (Figure 5).

3. Discussion

Puri et al. in their report of three cases of gastric cancer presenting with distant metastasis, describe a case of metastasis to the left forearm in the form of soft tissue lump and another case of fibular metastatic lesion [3]. Kammori et al. in their case report presented a 49 years old man who suffered from metastatic involvement of seventh cervical vertebra 9 years after total gastrectomy for gastric cancer [4]. Ichiyoshi et al. evaluated the results of 503 cases of early gastric cancer and found 3.4% rate of recurrence consisting of liver, lung, and bone metastasis [5]. In the report of Sano et al. of the long-term followup of 1475 cases of early gastric cancer, twenty cases (1.4%) of recurrence were found including 14 cases of bony metastasis [6]. Based on literature, it seems that although bone metastasis is a rare clinical finding in gastric cancer. It may be due to underestimation and using whole-body bone scan can detect significant percentage of bone metastasis. Choi et al. investigated the bone scan of 234 cases of advanced gastric carcinoma out of 17176 total cases of gastric carcinoma. 106 cases of bone metastasis were found among these cases [7].

4. Conclusion

Even though metastasis to bone is much more common in the axial skeleton and the roots of extremities, we should still expect to see them in unusual sites and from those cancers not so notorious in invasion to bone from.

Conflict of Interests

None of the authors of the paper has declared any conflict of interests within the last three years which may arise from being named as an author on the paper.


Authors are very grateful to Dr. Mehran Taghipour for his help in editing the paper.

1. Sugiura H,Yamada K,Sugiura T,Hida T,Mitsudomi T. Predictors of survival in patients with bone metastasis of lung cancerClinical Orthopaedics and Related ResearchYear: 2008466372973618196360
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3. Puri T,Gunabushanam G,Sharma DN,Julka PK. Distant metastases as primary presentation of gastric cancer: report of 3 casesJournal of the Hong Kong College of RadiologistsYear: 2005815962
4. Kammori M,Seto Y,Haniuda N,et al. A case of bone metastasis from gastric carcinoma after a nine-year disease-free intervalJapanese Journal of Clinical OncologyYear: 200131840740911574636
5. Ichiyoshi Y,Toda T,Minamisono Y,Nagasaki S,Yakeishi Y,Sugimachi K. Recurrence in early gastric cancerSurgeryYear: 199010754894952333591
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7. Choi CW,Lee DS,Chung JK,et al. Evaluation of bone metastases by Tc-99m MDP imaging in patients with stomach cancerClinical Nuclear MedicineYear: 19952043103147788986

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