CASE REPORT article
Front. Oncol.
Sec. Surgical Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1573165
Rare case of Signet Ring Gastric Adenocarcinoma with Rectal Metastasis
Provisionally accepted
- 1National University of Malaysia, Bangi, Malaysia
- 2Hospital Chancellor Tuanku Muhriz, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
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Gastric cancer remains a leading cause of cancer-related mortality worldwide, with the liver, peritoneum, lungs, and bones being the most common sites of metastasis. Rectal metastasis, also referred to as Schnitzler's metastasis, is extremely rare and may clinically mimic primary rectal carcinoma, complicating diagnosis and delaying appropriate management.We report a case of a 69-year-old male diagnosed with signet-ring cell gastric adenocarcinoma who presented with symptoms of large bowel obstruction and constitutional decline. Crosssectional imaging revealed a circumferential rectal mass and gastric wall thickening.Endoscopic biopsies of both gastric and rectal lesions confirmed poorly cohesive adenocarcinoma with signet ring features. Immunohistochemistry supported gastric origin of the rectal tumour. The patient underwent laparoscopic-assisted transverse colostomy for symptomatic relief but the planned gastrojejunostomy was abandoned due to extensive peritoneal involvement. He was treated with palliative chemotherapy (FOLFOX followed by modified de Gramont), achieving only transient radiologic response before clinical deterioration. Subsequent progression to lymphangitic carcinomatosis led to a shift toward best supportive care. This case highlights the diagnostic challenge posed by rectal metastasis from gastric cancer and underscores the aggressive nature and poor chemotherapy responsiveness of signet ring cell carcinoma. Clinicians should maintain high suspicion for secondary rectal lesions in patients with diffuse-type gastric cancer and lower gastrointestinal symptoms. Timely endoscopy, comprehensive histopathologic evaluation, and tailored palliative strategies remain essential to optimizing outcomes in such rare and complex presentations.
Keywords: gastric cancer, Signet-ring cell, Rectal metastasis, Peritoneal dissemination, Palliative Care
Received: 08 Feb 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Wan Jaffar, Hou Loo, Nik Mahmood and Mohammed. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guo Hou Loo, National University of Malaysia, Bangi, Malaysia
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