Metachronous metastasis to the right axillary lymph node and chest wall after curative gastrectomy in gastric adenocarcinoma: a case report

A 44-year-old man underwent curative distal gastrectomy for advanced gastric cancer (T4aN3aM0, stage IIIC). Twenty-three months later, the patient complained of an asymptomatic right axillary mass, positron emission tomography using fluorine-18 fluorodeoxyglucose (FDG-PET) demonstrated multiple enlarged lymph nodes involving the right axillary, while no evidence of recurrent disease was found in the abdomen. The patient underwent radical axillary lymph node (ALN) dissection, and pathological examination demonstrated metastatic adenocarcinoma. Four months later, the patient had an erythematous lesion on the anterior aspect of the chest wall. Histopathologic analysis revealed atypical cells exhibiting in the dermis irregularly. Cutaneous metastasis was diagnosed. The patient was treated with second-line chemotherapy and target therapy sequentially. However, the patient died eight months later. Taken together, this is the first case documenting axillary lymph node metastasis (ALNM) and cutaneous metastasis in a gastric adenocarcinoma. In order to achieve good prognosis, early detection is very important.