Cutaneous Nasal Metastasis of Gastric Carcinoma: An Unusual Case with Review of Literature

Abstract

Cutaneous metastasis from gastric adenocarcinoma is uncommon and usually indicates advanced disease. Nasal involvement is particularly unusual and may clinically mimic benign, inflammatory, infectious, or primary cutaneous lesions. This case report describes a 56-year-old man with a history of moderately differentiated intestinal-type gastric adenocarcinoma who presented with a painless, progressive nasal swelling of one month’s duration. He had previously undergone distal radical gastrectomy for gastric outlet obstruction, followed by capecitabine-based chemotherapy. Clinical examination showed a firm, non-tender mass involving the right ala and tip of the nose with surface ulceration. Fine needle aspiration cytology showed adenocarcinoma. Magnetic resonance imaging demonstrated a well-defined anterior right nasal mass with central cystic and necrotic changes, without involvement of the septum, nasal cavity, underlying bone, or brain. Palliative excision with right nasolabial flap reconstruction was performed for cosmetic improvement. Histopathology revealed a dermal infiltrating neoplasm forming glandular patterns in the nasal skin. Immunohistochemistry showed CK7 positivity and CK20 and GCDFP-15 negativity, supporting metastatic adenocarcinoma consistent with the known gastric primary in the clinical context. Subsequent imaging revealed liver and bilateral lung metastases. This case highlights the need to consider metastatic internal malignancy in unusual, persistent, or rapidly enlarging nasal cutaneous lesions, particularly in patients with a known history of cancer.