Cutaneous lymphatic spread after Stage III gastric cancer with signet-ring cells

What happened, in summary

A 72-year-old woman was diagnosed with Stage III gastric adenocarcinoma involving the antrum. She underwent partial gastrectomy with extensive lymph-node dissection. Pathology showed a poorly differentiated mixed-type adenocarcinoma with signet-ring cells and linitis plastica features involving the antrum and pylorus. Adjuvant capecitabine plus oxaliplatin was started after surgery, but she could not tolerate the treatment and it was discontinued. Ten months after surgery, CT showed a destructive bone lesion in the upper thoracic spine and enlarged left inguinal lymph nodes, indicating distant recurrence. Palliative radiation to the bone lesion provided substantial pain relief.

Over the following months, swelling developed in one leg and then both legs, progressing to severe lymphedema. She was hospitalized with extensive skin infiltration involving the lower limbs and extending toward the abdomen and upper-limb roots. A skin biopsy showed signet-ring carcinoma cells filling lymphatic vessels in the skin and subcutaneous tissue, confirming carcinomatous lymphangitis from the gastric cancer.

Palliative chemotherapy was started, but the metastatic disease continued to worsen. She developed respiratory failure and died. Because the cancer had spread to bone, distant lymph nodes and skin, her latest and highest documented stage is Stage IV.