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A cerebral clue in the stomach: Brain lesion leads to discovery of hidden gastric cancer.

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International journal of surgery case reports 2025 Vol.126() p. 110788
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Samani ZB, Elhaie M, Najafizade N

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[INTRODUCTION AND IMPORTANCE] Brain metastases from gastric adenocarcinoma are exceptionally rare, comprising only 0.1-0.16 % of all brain metastases.

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APA Samani ZB, Elhaie M, Najafizade N (2025). A cerebral clue in the stomach: Brain lesion leads to discovery of hidden gastric cancer.. International journal of surgery case reports, 126, 110788. https://doi.org/10.1016/j.ijscr.2024.110788
MLA Samani ZB, et al.. "A cerebral clue in the stomach: Brain lesion leads to discovery of hidden gastric cancer.." International journal of surgery case reports, vol. 126, 2025, pp. 110788.
PMID 39729896

Abstract

[INTRODUCTION AND IMPORTANCE] Brain metastases from gastric adenocarcinoma are exceptionally rare, comprising only 0.1-0.16 % of all brain metastases. These cases present unique diagnostic challenges, particularly when neurological manifestations precede gastrointestinal symptoms. Understanding such atypical presentations is crucial for timely diagnosis and appropriate management.

[CASE PRESENTATION] An 82-year-old male presented with non-specific neurological symptoms including dizziness, fever, and seizures, without any reported symptoms of primary gastric involvement. Initial neuroimaging revealed a left frontal brain lesion, which upon biopsy was confirmed to be an undifferentiated carcinoma. Subsequent positron emission tomography-computed tomography identified a primary gastric tumor with evidence of systemic metastatic spread.

[CLINICAL DISCUSSION] The case highlights the diagnostic complexity of brain metastases from gastric cancer, particularly when presenting without primary site symptoms. A comprehensive multi-modality diagnostic approach, including neuroimaging, histopathological analysis, and molecular studies, was essential for establishing the definitive diagnosis. Treatment involved a coordinated multi-disciplinary strategy combining systemic chemotherapy (capecitabine and oxaliplatin) with targeted brain radiation therapy.

[CONCLUSION] This case emphasizes the importance of maintaining a broad differential diagnosis and considering rare metastatic patterns, even in clinically atypical scenarios lacking primary tumor symptoms. It also underscores the value of comprehensive diagnostic evaluation and multi-disciplinary collaboration in managing such complex oncological cases.