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25 May 2022 : Case report  USA

[In Press] Pleural Effusion as the Initial Presentation of Gastric Adenocarcinoma: A Case Report

Unusual clinical course, Challenging differential diagnosis

Conner V. Lombardi1ABCEF, Logan D. Glosser ORCID logo1ACE, Spiro Veria1ACF, Wade Hopper ORCID logo2EF, Prabath Herath-Mudiyanselage3E

DOI: 10.12659/AJCR.935434

Am J Case Rep In Press; DOI: 10.12659/AJCR.935434  

Available online: 2022-05-25, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Gastric adenocarcinoma is a common malignancy, representing the third most common cause of cancer-related death globally. Most patients are initially asymptomatic, but as the cancer progresses, patients typically present with vague gastrointestinal complaints, including early satiety, heart burn, vomiting, or abdominal pain. Metastatic gastric cancer is relatively uncommon, with ~26% of patients having metastasis to a single site and 13% having metastases to multiple sites. The most common site of metastasis is the liver, followed by peritoneum, lung, and bone.
CASE REPORT
In this case report we describe a 73-year-old man who presented with shortness of breath, found to have large hiatal hernia along with segmental branch pulmonary embolism, bilateral pleural effusion, and diffuse interlobular septal thickening. The pleural effusion was later found to be malignant in nature and the patient was diagnosed with metastatic stage IV infiltrative gastric adenocarcinoma with metastasis to the lung and bone. Notably, the patient had no hepatic involvement.
CONCLUSIONS
This represents a unique case, as only 2% of malignant pleural effusions are attributable to gastric cancer. Furthermore, malignant pleural effusion is an extremely rare initial presentation of gastric adenocarcinoma, especially without liver involvement, with few existing cases documented in the literature. This case demonstrates that gastric cancer should be included on the differential diagnosis as a rare cause of pleural effusion.

Keywords: Adenocarcinoma; Pleural Effusion, Malignant; Positron-Emission Tomography

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923