title: A case of duodenal intramural metastasis from gastric cancer.
abstract: BACKGROUND
  Here, we report a case of duodenal intramural metastasis from gastric cancer, which is extremely rare.
  
  
  METHODS
  A 72-year-old man was admitted to our hospital with a chief complaint of lack of appetite in 2010. An endoscopic evaluation detected a Borrmann type 2 tumor occupying the lesser curvature of the gastric body and antrum, and pyloric stenosis. The patient underwent total gastrectomy. In an examination of the resected specimen, a type 2 tumor was identified in the middle gastric body and antrum, and a submucosal tumor was detected in the duodenal bulb. A histopathological examination demonstrated that the gastric tumor was not contiguous with the duodenal submucosal tumor. A microscopic examination demonstrated that the gastric tumor was a moderately to poorly differentiated adenocarcinoma and displayed lymphatic permeation. The duodenal submucosal tumor was also found to be an adenocarcinoma and was similar to the gastric tumor; therefore, we diagnosed the duodenal tumor as an intramural metastasis from gastric cancer.
  
  
  CONCLUSIONS
  The most common route of metastasis from gastric cancer involves hematogenous metastasis, lymph node metastasis, and peritoneal metastasis. Intramural metastasis from gastric cancer is rare and has been reported to be a variant of lymphogenic metastasis. The clinicopathological features of patients with duodenal intramural metastasis from gastric cancer are unclear because only one case of the condition has been reported.
  
  
  CONCLUSIONS
  Duodenal intramural metastasis from gastric cancer is an advanced form of cancer, and we suggest that it should be treated with surgical resection followed by adjuvant therapy.
authors.affiliation: Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Japan. Electronic address: tomo-ito@juntendo.ac.jp.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ito
authors.forename: Koichi
authors.initials: K
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maekawa
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Sakurada
authors.forename: Hajime
authors.initials: H
authors.lastname: Orita
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kushida
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Komatsu
authors.forename: Ryo
authors.initials: R
authors.lastname: Wada
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