Metastatic Neoplasms Involving the Stomach

Am J Clin Pathol. 2022 Jun 7;157(6):863-873. doi: 10.1093/ajcp/aqab202.


Objectives: Metastatic neoplasms involving the stomach are rare and diagnostically challenging if clinical history of malignancy is absent or unavailable. This study was designed to identify the tumors that most frequently metastasize to the stomach and the morphologic features that can provide clues to investigate the possibility of metastasis and predict the primary sites.

Methods: All patients with metastatic neoplasms involving the stomach were included in the study. The H&E- and immunohistochemical-stained slides were reviewed, and all clinical, endoscopic, and radiologic information was recorded.

Results: One hundred fifty patients, including 84 (56%) women and 66 (44%) men (mean age, 64 years), were identified. Gastric metastases were the initial presentation in 15% cases. Epithelial tumors (73.3%) comprised the largest group, followed by melanoma (20.6%), sarcomas (4%), germ cell tumors (1.3%), and hematolymphoid neoplasms (0.7%). Lobular breast carcinoma was the most common neoplasm overall in women, while in men, it was melanoma. Solid/diffuse growth pattern (75%) was more common compared with glandular morphology. The solid/diffuse category included lobular breast carcinoma (21.3%), melanoma (20.6%), and renal cell carcinoma (10.6%), while the glandular category was dominated by gynecologic serous carcinomas (7.3%) with papillary/micropapillary architecture.

Conclusions: Metastatic neoplasms should be considered in the differential diagnosis of gastric neoplasms, particularly those with a diffuse/solid growth pattern. Glandular neoplasms are difficult to differentiate from gastric primaries except for Müllerian neoplasms, which frequently show a papillary/micropapillary architecture.

Keywords: Breast; Carcinoma; Melanoma; Metastasis; Secondary; Stomach.

MeSH terms

  • Breast Neoplasms*
  • Carcinoma, Lobular*
  • Cystadenocarcinoma, Serous*
  • Female
  • Humans
  • Kidney Neoplasms* / pathology
  • Male
  • Melanoma* / pathology
  • Middle Aged
  • Ovarian Neoplasms* / pathology
  • Stomach / pathology
  • Stomach Neoplasms* / diagnosis
  • Stomach Neoplasms* / pathology