Primary gastric cancer presenting with a metastatic embolus in the common carotid artery: a case report
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Primary gastric cancer presenting with a metastatic embolus in the common carotid artery: a case report Ying Zhang1, Xiu-feng Zhang2, Wei-hui Shentu1, Guan-gen Yang2, Zhong Shen2 and Pin-tong Huang1*
Abstract Although about 30% of gastric cancers have distant metastasis at the time of initial diagnosis, metastatic tumor embolus in the main blood vessels is not common, especially in the main artery. The report presents, for the first time, an extremely rare clinical case of a metastatic embolus in the common carotid artery (CCA) from primary gastric cancer. Metastatic embolus from the primary tumor should be considered when patients present with gastric cancer accompanied by intravascular emboli. The patient should be actively examined further so as to allow early detection and treatment. Keywords: Tumor embolus, Common carotid artery, Metastasis, Gastric cancer
Background Metastatic tumor embolus in the common carotid artery from primary gastric cancer is an exceedingly rare event. Here, we report on the case of a 69-year-old male with primary gastric cancer presenting with a metastatic tumor embolus in the common carotid artery who underwent a palliative subtotal gastrectomy and endarterectomy, which is the first report of metastatic embolus in the common carotid artery in English and non-English literature. Case presentation The patient was a 69-year-old male patient who had been hospitalized for four days with sudden left limb weakness. Four days previously, during outdoor activities, this patient had felt sudden left limb weakness accompanied by instability in holding materials with his left arm, unsteady gait of his left leg and impaired speech articulation. Physical examination revealed: conscious, heart and lung (−); neurological symptoms: isocoria, light reflex was normal, mouth slightly favored the right, the left nasolabial fold was a little shallow, tongue lolled to the left side, * Correspondence: [email protected] 1 Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University College of Medicine, No.88 Jiefang Road, Hangzhou, Zhejiang 310009, China Full list of author information is available at the end of the article
left side paresis test (+), Pakistan’s sign of the left side (±), Pakistan’s sign on the right side (−), limb muscle strength and muscular tension was normal. Emergency cranial computed tomography (CT) scan in another hospital showed that hypodense lesions in the right basal ganglia were detected and the diagnosis of cerebral infarction was considered (Figure 1). In our hospital, magnetic resonance imaging (MRI) examination revealed right basal ganglia cerebral infarction and ischemic lesions (Figures 2-A.B). Carbohydrate antigen (CA) 19–9: 12.35U/ml, carcinoembrionic antigen (CEA): 25.28ng/ml, CA72-4: 21.73U/ml. The patient denied having ‘hepatitis, tuberculosis, diabetes, hypertension, coronary heart disease’ and gave a family genetic history. He related a history of ‘chronic gastritis’ for the last thr
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