Metastatic gastric cancer presenting as a solitary axillary cutaneous nodule.

An 84-year-old man, with a medical history of dilated cardiomyopathy, was admitted to our hospital with a nodular lesion in his right axilla of 6 weeks' duration. There was no history of weight loss, nausea, or vomiting. Physical examination revealed a red-violet axillary nodule, 7 cm in diameter and 3 cm thick, with an ulcerated surface (Fig. 1). A palpable right adenopathy was also found. The rest of the physical examination was normal.A metastatic tumor from an unknown origin was suspected. A biopsy of the cutaneous nodule was performed.Hematoxylin and eosin staining revealed a round and well-defined nodule, located in the dermis. The nodule was composed of solid nests of atypical cells, with large nuclei and scanty cytoplasm, which tended to form a pseudoglandular pattern (Fig. 2). Atypical mitotic figures were frequently seen. Immunohistochemical examination of the tumoral cells showed a positive reaction with carcinoembryonic antigen and cytokeratin KL1 and a negative reaction with antileukocyte antibody.With these histologic findings, a diagnosis of cutaneous metastasis was made. Blood laboratory evaluation revealed an elevated erythrocyte sedimentation rate (43 mm/h). Tumor markers, including alpha-fetoprotein, carcinoembryonic antigen, prostate-specific antigen, squamous cell carcinoma antigen, and carbohydrate antigen 19-9, were all within normal limits. A chest X-ray film was normal and an occult blood test was also negative.Neck and chest computed tomography scan identified some adenopathies located on the neck and the right axilla. Barium studies showed an intramural mass lesion in the minor curvature of the stomach. An upper gastrointestinal tract endoscopy showed a submucosal nodule in the cardia. Biopsy of this gastric nodule demonstrated a poorly differentiated carcinoma. Biopsy of both cervical and axillar lymph nodes was performed and no tumoral cells were found.Abdominal-pelvic computed tomography scan and bone scintigraphy showed no pathologic findings. Although supportive chemotherapy was performed, the patient died 6 months later.