We report a 72-year-old woman with rare
metastases of
gastric cancer to the bone, skin, and ovary occurring more than 8 years after distal
gastrectomy, which were subsequently effectively controlled. Histopathological diagnosis revealed signetring cell
carcinoma, and the comprehensive findings were pT4a, pN3, ly2, v0, and Stage III c. The
adjuvant chemotherapy of S- 1 plus
cisplatin(CDDP)was switched to S-1monotherapy for 4 years and then to
tegafur/
uracil(UFT)for an additional year. Eight years after the operation, I-
CTP and
alkaline phosphatase(ALP)levels were elevated, and bone scintigraphy revealed bone
metastasis. The patient's ALP levels, which had increased to 6,617 U/L, remarkably decreased to 359 U/L 17 months
after treatment with
zoledronic acid. About 9 years after the operation, a 2cm subcutaneous node was seen on the patient's scalp, and a biopsy was performed. Histologically, the node was confirmed as a
signet-ring cell carcinoma. S-1
therapy was initiated, and the node disappeared within 8 months. About 10 years after the
gastrectomy, abdominal computed tomography( CT)scans indicated a
tumor sized 11×10 cm in the pelvis, and a biopsy was performed. Histologically, the
tumor was a
signet-ring cell carcinoma appearing as an ovarian
metastasis of
gastric cancer.
Ovariectomy was performed. Peritoneal dissemination was not detected. The patient was treated with S-1 plus
oxaliplatin and
zoledronic acid, and continues to remain in good condition 9 months after the
ovariectomy.