Metastatic gastric cancer mimicking pulmonary sarcoidosis

Abstract

Introduction. Stomach cancer is the fifth most common oncological disease in the world and poses a diagnostic difficulty due to its often asymptomatic course. Usually, the first clinical signs are associated with lesions of abundant metastasis in the liver, peritoneum, and lungs. In rare cases, pulmonary metastases may resemble granulomatous disease, such as sarcoidosis. Case Description. In September of 2020 a 30-year-old man with a 2-month history of dyspnea, wheezing, and pain in the chest was admitted to the hospital. There were no gastrointestinal complaints nor abnormal findings in the physical examination. Initial chest radiograph showed pulmonary infiltrates, predominantly in upper and middle lobes bilaterally – 3rd stage sarcoidosis was suspected. Subsequent chest computer tomography (CT) exhibited additional findings: lymphostasis, hilar and mediastinal lymphadenopathy, interlobular septal thickening, and diffuse perilymphatic nodules, and supported the primary hypothesis. However, surprisingly, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) revealed adenocarcinoma with a signet-ring morphology, and the spread of oncoprocess from the gastrointestinal tract was suspected. Chest, abdomen, and pelvic CT exhibited additional findings of ascites, multiple liver, and peritoneal metastases, and highlighted the primary focus of the tumor - gastric cardiac carcinoma. Finally, esophagogastroduodenoscopy with biopsy was performed and confirmed an infiltrative tumor of the gastric body. Summary. Stomach cancer is a common oncological disease. In rare cases, its pulmonary metastases may resemble granulomatous disease, such as sarcoidosis. This report demonstrates a case of a 30-year-old male with an atypical radiological appearance of pulmonary metastases from gastric adenocarcinoma. Conclusion. While lung metastases typically appear as well-defined, rounded lesions, the presence o[...].