[A Case of Multiple Brain Metastasis after Resection of Gastric Cancer with Adrenal Metastasis]

A 67-year-old man was brought to our hospital by ambulance because of vomiting and lightheadedness. He was diagnosed with gastric cancer and multiple lymph node and left adrenal metastases. No other organ metastases were observed. Total gastrectomy and left adrenalectomy were performed. Combination therapy with S-1 and cisplatin(CDDP)for gastric cancer(pT4aN3bM1, pStage Ⅳ)was initiated but later discontinued because of diarrhea, acute renal failure, and pancytopenia. While hospitalized for chemotherapy side effects, he fell and was diagnosed with cerebellar infarction based on head computed tomography(CT)and magnetic resonance imaging(MRI)findings. Subsequently, an increase in carcinoembryonic antigen levels was observed, and combination therapy with ramucirumab(RAM)and paclitaxel(PTX)was initiated; however, chemotherapy was discontinued due to severe fatigue. On postoperative day 207, he was found to have impaired consciousness and was transported to the emergency department of the hospital. He was diagnosed with brain metastases using CT and MRI. The patient died in a coma on postoperative day 264. Adrenal and brain metastases from gastric cancer are relatively rare and their prognosis is poor. Hematogenous metastases to the whole body should be suspected when an adrenal metastasis is found, and a thorough examination of the head is also considered necessary.