A case of metachronous brain metastases from gastric cancer with no recurrence

A 75-year-old man with acute myeloid leukemia brought to complete remission by systemic chemotherapy was diagnosed by gastrointestinal endoscopy with advanced gastric cancer of the upper stomach during examination for severe anemia. He underwent total gastrectomy with D2 lymphadenectomy. One year and 5 months later, he underwent magnetic resonance imaging (MRI) of the brain due to changes in personality and vomiting. MRI showed three cerebral metastases, but computed tomography (CT) of the chest and abdomen and ultrasound imaging of the abdomen found no other metastasis. Tumor markers were within normal limits. The brain tumor was biopsied because acute myeloid leukemia recurrence could not be ruled out, and histopathological examination showed moderately differentiated adenocarcinoma consistent with gastric cancer, yielding a definitive diagnosis of brain metastases from gastric cancer. He underwent cyberknife radiosurgery to lessen clinical symptoms and was discharged. Although a second cyberknife radiosurgery was required for two brain metastases 5 months after initial radiosurgery, he is doing well without evidence of metastases to the brain, chest, or abdomen, one year after the diagnosis of brain metastasis.