Clinical features

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Gastrointestinal symptoms may occur in up to 50% of patients with gastric metastases. Bleeding and abdominal pain are the most common clinical features, followed by vomiting and anorexia. Intestinal and gastric metastases were found after a median interval of 6 years (range, 0.12-12.5 years) following the diagnosis of primary breast cancer {1700}. Gastric metastasis from a breast cancer has occurred up to 30 years after diagnosis of the primary neoplasm {1148}. Occasionally, metastatic breast cancer in the stomach is detected before the primary tumour is diagnosed.

Imaging and endoscopy

An upper gastrointestinal endoscopy study identified 14 metastatic tumours in the upper gastrointestinal tract, 13 of which were in the stomach {873}. Many

Fig. 3.53 Multiple gastric metastases from rhabdomyosarcoma of the spermatic cord in a 15-year old boy.

metastases are described as volcanolike ulcers {618; 1108}. On endoscopy, pigmentation may not be evident in some melanomas {1069}. In patients with meta-static lobular breast carcinoma the endo-scopic appearance may be that of linitis plastica. In such cases, conventional biopsies may be too superficial to include diagnostic tissue in the submu-cosa. Endosonography may help direct attention to the deeper infiltrate {1097}. Gastric melanomas often appear as polypoid or target lesions on barium X-ray studies {1718} and, less commonly, as a submucosal mass {1148}.

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