Can Metastatic Lymph node ratio be used as an independent prognostic factor in Carcinoma tongue?

V.M Bharath, P.G. Balagopal, Abraham George Nebu, A.V. Jayasudha, M. Iqbal Ahmed, Paul Sebastian
Division of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India

Background: Lymph node metastasis is an established prognostic factor in carcinoma of tongue. The association between lymph node ratio (LNR, the ratio of positive lymph nodes to the total number of dissected lymph nodes) and survival has been recently studied. But the available literature is mostly retrospective in nature and they take the broad group of oral squamous cell carcinoma as a whole and not as a single sub-site; also it does not take in to consideration the importance of standardising the minimum number of lymph nodes to be dissected or a single head and neck pathologist examining the specimen to avoid wide variations in the ratio and to reduce the bias. Hence we sought to determine using a prospective study whether the lymph node ratio, as an independent factor impacts survival in node-positive squamous cell carcinoma of tongue and whether a cut-off can be arrived at to risk stratify the patients.

Methods: We prospectively studied 51 consecutive pathologically node positive patients with squamous cell carcinoma tongue who satisfied our selection criteria. A standard surgery for the primary was done under frozen control and a comprehensive neck dissection, with the minimum number of lymph node harvest kept at 15. All the specimens were examined by a single head and neck pathologist. Further adjuvant treatment was given according to our institution protocol. They were followed up with a regular clinical examination for an average period of 24 months. The 2 Yr OS and DFS were calculated using the Kaplan Meier method. LNR was subjected to univariate and multivariate analyses.

Results: The 2 yr OS was 37.8 % for patients with LNR> 0.10 compared with 88.2 % for patients with LNR <0.10 (p value=0.0187).Similarly, the DFS was 46.3% for patients with LNR > 0.10compared with 83.6% for those with LND<0.10 (p value=0.0859).LNR was a significant prognostic factor in both univariate and multi variate analyses.

Conclusion: In squamous cell carcinoma of tongue, an increased Lymph node ratio (LNR) is a strong predictor of decreased survival. A lymph node ratio (LNR)> 0.10 is associated with a worse outcome.

Keywords: Squamous cell carcinoma, tongue, lymph node, ratio, prognosis

Synergistic Protective Effect of Sickle Cell Trait and Blood Group-O on the Risk of Endemic Burkitt’s Lymphoma

Sagir G. Ahmed¹, Umma A. Ibrahim², Modu B. Kagu³

1. Department of Haematology, Aminu Kano Teaching Hospital, Kano State, Nigeria

2. Department of Paediatrics, Aminu Kano Teaching Hospital, Kano State, Nigeria

3. Department of Haematology, University of Maiduguri Teaching Hospital, Maiduguri Borno State, Nigeria

Background: Previous research strongly suggest that malaria is an important factor in the pathogenesis of endemic Burkitt’s lymphoma (eBL). Therefore, genetic factors such as sickle cell trait (SCT) and blood group-O that offer protection against severe malaria would be expected to reduce the risks of eBL. However, previous reports on the protective roles of SCT and blood group-O against the risks of eBL were inconclusive. Hence, the need for further studies on the protective roles of SCT and blood group-O separately, and also to investigate whether or not the combined anti-severe malaria protective roles of SCT and blood group-O have synergistic effects in reducing the risks of eBL. We therefore hypothesize that SCT and blood group-O are independently associated with reduced risks of eBL, and the co-inheritance of both factors (SCT and group-O) would provide greater protection against eBL. If our hypothesis is correct, children who inherited both SCT and blood group-O would have lower risks of eBL than their counterparts who inherited SCT or blood group-O separately. To the best of our knowledge, the possible synergistic relationship between SCT and blood group-O with regards to the risk of eBL has not been previously studied.

Patients and Methods: We conducted a retrospective logistic regression analysis of the frequencies of Hb phenotypes and ABO blood groups among patients with eBL in order to determine the separate and synergistic protective effects of SCT and blood group-O on the risk of eBL in Nigeria where eBL is among the most common malignant childhood cancers. Results: The Odd Ratios (OR) for the risk of eBL were 0.52 for ‘SCT irrespective of ABO blood group’; 0.49 for ‘blood group-O irrespective of Hb phenotype’; and 0.23 for ‘SCT with blood group-O’.

Discussion: These values suggest that both SCT and blood group-O are independently associated with modest reduction in the risk of eBL. However, when SCT with blood group-O was assessed for the risk factor for eBL, we obtained an Odds ratio of 0.23, which was significantly lower than the OR values for SCT (0.52) and blood group-O (0.49) separately. These figures suggest that coinheritance of SCT and blood group-O offers greater reduction in the risk of eBL than that provided by either SCT or blood group-O separately. The greater protection against eBL provided by the coinheritance of SCT and blood group-O is interpreted to be the resultant synergistic effect of the combined anti-malarial attributes of SCT and blood group-O.

Conclusion: These findings suggest that the combined anti-malarial protective roles of SCT and blood group-O have synergistic effects in reducing the risks of eBL. This study has provided further evidence on the association between malaria-protective genetic polymorphisms and eBL, which is consistent with the aetiologic role of malaria in the pathogenesis of the tumour. Hence, the need for malaria endemic countries to intensify malaria control programs in order to curtail the incidence of eBL.

Keywords: Endemic Burkitt’s Lymphoma, Risk Factors, Sickle Cell Trait, ABO Blood Group

Clinicopathological Spectrum of Anaplastic Carcinoma of Thyroid – 5 Year Experience from a Tertiary Cancer Centre

Pattamparambath Manjusha¹, Joseph Philip Kandathil¹, Sangeetha K. Nayanar¹, Joneetha Jones², Babu Sajith³

1. Dept. of Oncopathology and Translational Research, Malabar Cancer Centre, Thalassery, Kannur,Kerala, India

2. Dept. of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kannur,Kerala, India

3. Dept. of Surgical Oncology, Malabar Cancer Centre, Thalassery. Kannur,Kerala, India

Background: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive and lethal solid tumors known to affect humans. Although ATC accounts for only 1% to 5% of all thyroid tumors, it portends a dismal prognosis with a median survival of 4 to 12 months from the time of diagnosis. In this retrospective review we aim to study the clinical, cytological and histopathological features and management of ATC cases reported in our institution.

Materials and methods: Twenty-two patients with ATC were identified from institutional database between January 2012 and December 2016. Clinicopathologic data and survival data was obtained from the medical records. Fine needle aspiration cytology (FNAC) slides and histological slides were reassessed for the predominant morphologic findings.

Results: Of the 22 patients, 8 were male and 14 were female. The median age at presentation was 70 years (range 50-85 years) with a median survival of 3 months. A history of pre-existing thyroid disease was present in 32% of the patients. Distant metastases were seen in 41% of patients. FNAC findings noted were pleomorphic vesicular nuclei, multinucleated giant cells, necrotic background, atypical squamoid cells, spindle cells and atypical mitosis. Majority of the patients (59%) received palliative radiotherapy as treatment.14% underwent total thyroidectomy and remaining 27% received best supportive care.

Conclusion: ATC remains a highly lethal disease with limited survival .FNAC can serve as a reliable tool in the early diagnosis. With several drugs in clinical trial, the therapeutic scenario of ATC might improve in future.

Keywords: ATC, FNAC, Multinucleated giant cell, Retrospective, Survival.

Investigating the relationship between psychological hardiness and resilience with depression in women with breast cancer

Mitra Tadayon¹, Saeideh Dabirizadeh¹, Kourosh Zarea², Nasser Behroozi³, Mohamad Hossin Haghighizadeh⁴

1. Menopause and Andropause Research Center, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2. Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3. Psychology Department, Shahid Chamran University of Ahvaz, Khouzestan, Iran.

4. School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Considering the fact that depression in patients with breast cancer increases the severity and complications of medical treatments such as chemotherapy (including fatigue, nausea, and cognitive problems), the identification of its related factors can be one of the important steps in reducing the complications of this disease. Therefore, the purpose of this study was to determine the relationship between psychological hardiness and resilience with depression in women with breast cancer.

Materials and Methods: The present study was a descriptive-analytic study, the population of which included all women with breast cancer under chemotherapy referred to Oncology Center of Imam Hassan Mojtaba Hospital in Dezful city from July 2015 to December 2016. A sample size of 114 people was selected. Data collection instruments included demographic information form, Ahvaz Psychological Hardiness Scale, Connor-Davidson Resilience Scale (CD-RISC), and Beck Depression Inventory. Data were analyzed using SPSS ver.21.

Findings: Findings showed that 61.4% of respondents had depressive symptoms. Mild, moderate and severe depression symptoms were prevalent among 37.7%, 20.2% and 3.5% of the participants, respectively. Also, there is a significant relationship between resiliency and hardiness with depression in women with breast cancer (P<0.05).

Discussion and Conclusion: The depression rate in women with breast cancer decreased if hardiness and resiliency against the disease has been increased. This means that there is a need for training courses and counseling services for women with breast cancer in order to improve their mental health status.

Keywords: Breast cancer, Depression, Resiliency, Hardiness

Clinicopathological outcome of ovarian granulosa cell tumors

Objective: The aim of our study was to analyze the clinical and pathological characteristics of women who were diagnosed with malignant ovarian granulosa cell tumors and managed at single institution.

Materials and methods: A retrospective study was conducted regarding patients who were diagnosed with ovarian granulosa cell tumors and received treatment at King Hussein Medical Center. Data was extracted from the patient’s files and reports from the period 2007 to 2017 (over ten years period). The collected data included patient’s characteristics for age, parity, presenting symptoms, marital and menopausal status. Tumor characteristics included the site, size, mitotic index, type and associated uterine pathology. Other data included the type of surgery performed, adjuvant treatment provided, outcome data regarding tumor stage, recurrence and survival. Data was revised, arranged in tables and statically analyzed.

Results: Twenty-one cases of ovarian granulosa cell tumors were identified. The median age of cases was 45.5 years (range of 17-76). Abdominal pain was the most common presenting symptom11/21 (52.4%). Endometrial hyperplasia was associated with ovarian tumor in six patients (28.6%) and endometrial cancer in three cases (14.3%). The primary surgery ranged from unilateral cystectomy to hysterectomy, bilateral salpingooophorectomy, and debulking surgery. Stage I-II were recorded in 18/21 (85.7%) of the cases, while stage III-V were found in 3/21 (14.3%). No adjuvant treatment was required in 11 cases (52.4%). Less than five years survival was 19% (4/21). Over all recurrence rate was 23.8%.

Conclusion: Granulosa cell tumors is a rare ovarian malignancy. Surgery is the standard treatment with a role for fertility preservation. Most tumors are diagnosed at an early stage with very good outcomes. Recurrence and survival are related mainly to initial tumor stage, however, further studies are needed to study the effect of other factors on outcome.

Keywords: Granulosa cell tumor, pathological, ovary

Anaplastic Carcinoma Thyroid - A Review on the Management of this Aggressive Cancer

Syed Afroze Hussain, S. Subbiah, M.S. Bharathiraja

Department of Surgical Oncology, Government Royapettah Hospital, Chennai, India

Anaplastic carcinoma thyroid is an aggressive malignancy with very poor survival rate. In this study, we reviewed the records of 34 patients with anaplastic carcinoma thyroid in our centre and we divided them into groups T4a, T4b, and T4c. The case records were reviewed for presentation, diagnosis, treatment and follow-up and we analysed the data using statistical methods. The median age group was 65 years with 22 women and 12 men. There were 16 patients (47%) with a history of thyroid swelling of more than 2 years duration. Of these 16 patients 6 were found to be in T4a group. There were 6 patients in T4a, 14 each in T4b and T4c. All the patients in T4a group were operated and completed multimodal management. The group with T4a had the best prognosis with a mean survival of 1 year. The patients with extracapsular disease (T4b) completed chemotherapy along with radiotherapy. These patients had a mean survival of 6 months. Only 2 patients in metastatic group completed the course of chemotherapy with radiotherapy. The other 12 patients died during the course of treatment due to respiratory failure. The mean survival in this group was a dismal 15 days. On univariate analysis metastatic disease, extracapsular disease, size more than 5 cm and involvement of lymph nodes were the reasons for incomplete treatment and hence markers of worst prognosis. There are 47% of the patients with prior history of thyroid swelling which gives us time to identify and manage thyroid swellings with propensity to undergo anaplastic transformation.

Keywords: Anaplastic carcinoma thyroid, Total thyroidectomy, Targeted therapy.

Prevalence of Stomach Cancer in Isfahan Province, Iran

Zahra Tolou Ghamari

Isfahan Kidney Transplantation Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Background: Due to nonspecific early symptoms, there is significant discrepancy related to the incidence of gastric cancer around the world. The aim of this study was to provide data related to period prevalence (PP) and incidence (Irs) of stomach cancer in Isfahan, Iran.

Patients and Methods: Information related to the Surveillance, Epidemiology, and End Results; (SEER) was collected from the Isfahan Cancer Registry. Period prevalence (PP) was calculated per 100000 persons. The cancer sites studied were defined according to the International Classification of Diseases (ICD-O; Third Edition) and recorded by topography code (C16).

Results: Among all registered stomach cancers, there were 2039 cases of gastric cancer including 68% males. The mean age of patients was 66.1 ± 14.8 years. Age reported stomach cancer was less than 50 years in 13%. With a total PP of 40.9, this value was 2 times higher in males when compared to females (54.5 Vs 26.8; p<0.05). Incidences were with values of: 9.9 (2011-2012), 10.6 (2012-2013), 10.3 (2013-2014) and 10 (2014-2015) per 100 000 persons, respectively. There were 45% reported death among total population.

Conclusion: The PP for stomach cancer in male population was approximately 2 times higher than females. There was an increase in the Irs over the study period. To facilitate early diagnosis for better management associated to pharmacotherapy or surgical care, our findings emphasized that health-care plans should focus on greater effort toward genetic and environmental factors in Isfahan Province/Iran.

Keywords: Stomach, Prevalence, Incidence, Isfahan, Iran.

Accuracy of intraoperative frozen section evaluation of sentinel lymph node biopsy in breast cancer: Our experience in Bahrain

 Raed Almarzooq, Amal Alrayes, Ahmed Saeed, Hussain Abdulla

Department of Surgery, Salmaniya Medical Complex, Bahrain

Introduction: Intraoperative frozen section of sentinel lymph nodes (SLN) in clinically node-negative breast cancer patients is performed to stage the axilla and allows axillary lymph node dissection (ALND) to be avoided in the same operative setting. The aim of this study was to evaluate our institutional experience on the accuracy of intraoperative frozen section of sentinel lymph node biopsy (SLNB) in breast cancer patients.

Methods: Clinicopathological data from patients who underwent surgery for breast cancer with SLNB from January 2013 to May 2017 at Salmaniya Medical Complex (SMC) in Bahrain were collected retrospectively. Results of intraoperative frozen section were compared to paraffin section to determine accuracy, sensitivity, specificity, positive-predictive value (PPV), negative predictive value (NPV) and false-negative rate (FNR).

Results: A total of 104 patients with breast cancer underwent breast surgery with SLNB and intraoperative frozen section evaluation of SLNB. Frozen section correctly identified a positive or negative result in 97 cases (accuracy 93.2%). The sensitivity was 77.7%. The specificity was 98.7%. The PPV was 95.4%. The NPV was 92.6%. The overall FNR was 22.3%.

Conclusion: Our results show that intraoperative frozen section can reliably evaluate the status of SLNB in patients with breast cancer, allowing us to avoid second stage surgery in most women.

Keywords: breast cancer, frozen section, sentinel lymph node biopsy, axillary lymph node dissection.

Laparoscopy as a Primary Investigatory Tool in Pediatric Abdominal Masses

Ossama M. Zakaria^1,3, Mohamed Yasser I Daoud¹, Tamer A. Sultan², Karam El Sayem³, Hazem M. Zakaria⁴, Amr M. El-Gibaly⁵, Fouad M Sedky⁴, Assma Al Taher¹, Hamed A Al Wadaani¹

1. Division of Pediatric Surgery; Dept. of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia

2. Division of Pediatric Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt

3. Division of Pediatric Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

4. Department of Surgery, KFH Imam Abdulrahman Bin Faisal University College of Medicine, Dammam, Saudi Arabia

5. Hanse Klinikum Stralsund, Department of General, Visceral, Thoracic and Vascular Surgery, University Medicine of Greifswald, Germany

Background: Management of abdominal masses still pose a major challenge for pediatrician and surgeons with many controversy as regards the best investigatory tools.

Aim of the Work: This study was designated to evaluate the role of diagnostic laparoscopy in investigating equivocal pediatric ^masses that had undergone other imaging modalities.

Patients and Methods: A combined prospective and retrospective multicenter study over a period of 12 years from January 2005 to December 2016 was undertaken. This study included all children aged from 3 months to 15 years. Those having a documented diagnosis through other imaging modalities such as sonographic and/or computed tomography (CT) guided biopsy were excluded. All patients underwent multiport diagnostic laparoscopy for biopsy of the mass. All specimens were histologically assessed basically using Hematoxylin and Eosin (H and E) staining; some specimens had been immunohistochemically studied.

Results: One hundred and thirty-two patients were recruited in the study. They were 69 males and 63 females with a male to female ratio of1.1:1. The age ranged from 3 months up to 15 years with the mean age of 2.7 ± 0.8 years. Out of the total studied group, 54 patients were diagnosed with neuroblastoma (40.9%), while 66 (50%) were having nephroblastoma. The remaining 12 (9.1%) were having non-Hodgkin’s abdominal lymphoma. Not all patients showed any complication related to the procedure. The mean follow up period was 3.6 years. Most of the cases (n=121) despite having a different diagnosis, were clinically staged as grade I to grade II (91.7%). Neither intraoperative nor postoperative complications were recorded during this technique. The mean operative time was 72 mins ± 20 in the earliest group; yet, it has declined to be 32 ± 12 minutes in the latest group due to the advancement of the learning curve.

Conclusion: Laparoscopy is accurate and safe for investigating pediatric solid abdominal masses. It should be used as the sole tool for biopsy of solid abdominal tumors in pediatrics.

Keywords: Laparoscopy, Abdominal Masses, Biopsy

Survival Outcome of Pulmonary Metastasectomy Among Patients with Sarcoma and Colorectal Primary Cancers: A Single Institute Experience

Abdulrahman A. Alghamdi^1,2, Manar A. Hasabullah^1,2, Alhanouf I. Alhusani^1,2, Leema K. Alhussayen^1,3, Khawlah M. Fairaq ^1,4, Samar S. Alsifri^1,5, Turki M. Al-Fayae^1,2,6

1. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

2. King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Jeddah, Saudi Arabia

3. Taibah University, College of Medicine, Madinah, Saudi Arabia

4.  King Abdulaziz University, College of Medicine, Jeddah, Saudi Arabia

5.  Ibn Sina National College, Jeddah, Saudi Arabia

6.  Dept. of Adult Medical Oncology, Princess Norah Oncology Center, NGHA, Jeddah, Saudi Arabia

Background: One of the most common organs targeted by metastatic malignancies are the lungs. In the field of surgical oncology, pulmonary metastasectomy (PM) is frequently performed for patients with pulmonary metastatic nodules secondary to specific primary tumors. This study aimed to evaluate survival and its predictors among patients with primary sarcoma or colorectal cancer who underwent PM at the Princess Norah Oncology Center, Jeddah, between 2007 and 2016.

Patients and methods: Sarcoma and colorectal cancer patients with isolated lung metastasis and who underwent PM in our institution between 2007 and 2016 were identified. Overall survival and possible survival predictors were assessed using log-rank test and multivariate analysis was implemented using Cox regression.

Results: Thirty-eight patients (16 with colorectal cancer and 22 with sarcoma) were identified. The median follow-up duration was 26 months (range 0–88). A total of 11 patients (28.9%) died during the follow-up period. The 5-year survival rates for patients who underwent PM with primary colorectal and sarcoma were 89% and 41%, respectively. Univariate analysis indicated that PM in patients with primary colorectal cancer was associated with longer overall survival (p value = 0.023) compared with PM with sarcoma. In the multivariate analysis, a metastatic lesion with size = 15 mm and having primary colorectal cancer were the factors significantly associated with prolonged survival.

Conclusion: Our experience has shown a substantial 5-year survival benefit for patients with primary tumors of sarcomas and colorectal cancer who underwent a PM. A primary tumor of the colorectum and larger pulmonary metastases were associated with a better outcome. We recommend PM, following careful selection, for patients with pulmonary deposits secondary to a primary tumor of Colorectum or sarcoma.

Keywords: Pulmonary Metastasectomy, Survival Analysis, Sarcoma, Colorectal Cancer

The Role of Surgery in Palliative Care of Cancer: A Review

Aakanksha Goel, Pankaj Kumar Garg
Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, India

It is often said ‘what cannot be cured has to be endured’. However, the endurance of suffering can at least be minimized by a surgeon. Traditionally, healthcare research has mainly centered over treatment approaches which increased the longevity of patients with incurable cancer. However, in addition, the focus is now also on the role of surgical intervention in palliation of symptoms of these patients, in order to provide them with comfort and dignity along with end-of-life medical care. Any surgical procedure undertaken to relieve symptoms and to enhance quality of life, with little or no bearing on overall survival of the patient, constitute a part of ‘Palliative Surgery’. Surgery comprises a potentially viable option of palliation. However, it should not prove to be an unfavorable treatment to the patients. An effective and quality palliative surgery requires assessment of optimal timing and selection of suitable operative procedure(s) with a minimal perioperative morbidity and mortality.

Keywords: Palliative surgery; Palliative treatment; Cancer; Advanced malignancy

Life threatening bleeding from an osteonecrosis of the jaw: Are bisphosphonates safe in irradiated head and neck cancer patients?

Tarek Assi^1,2, Ralph Chebib², Sara Lakiss², Joseph Kattan²

1. Gustave Roussy, Université Paris-Saclay, Département de Medecine Oncologique, France

2. Hotel Dieu de France University Hospital, Department of Medical Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

Osteonecrosis of the jaw is a significant complication secondary to radiation therapy or drug therapy, most commonly bisphosphonates. Safety data regarding the administration of bisphosphonates in bone metastatic head and neck cancer patients with history of jaw irradiation are almost non-existent. In this paper, we report the case of a Head and Neck (HNC) patient, with history of radiation therapy to the mandible region, treated with intravenous bisphosphonates for bone metastases that resulted in gross, life threatening mouth hemorrhage secondary to advanced, locally invasive ONJ.

Keywords: osteoradionecrosis; osteonecrosis of the jaw; bisphosphonates; head and neck cancer; radiotherapy.

Right Temporal Brain Metastases Arising Three Years after Curative Resection of Gastric Cancer: A Case Report

Ayman Zaki Azzam^1,2, Mohammad Anas Dababo³, Kareem Ayman Azzam⁴, Meshal Almeshal², Tarek Mahmoud Amin²

1. General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt

2. Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

3. Pathology and Laboratory Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

4. Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

Background: Gastric cancer can metastasize to multiple organs but the metastases to brain is very rare. We report a case of recurrent gastric cancer. The only site of recurrence is brain metastases that occurred three years after curative resection.

Case presentation: A 58-year-old male patient who was diagnosed to have gastric cancer. He received neoadjuvant chemotherapy then complete resection. The patient came to the outpatient clinic for regular follow up. After three years from resection the patient complained of headache and seizures. CT scan brain showed right temporal bone localized tumor. Complete resection was done which revealed it is a localized metastases from gastric cancer.

Conclusion: Localized brain metastases from gastric cancer is a rare event. Urgent CT scan must be done if the patient had any neurological complaint. Early diagnosis is the key for the patient management. Rapid treatment can improve the patient general condition and neurological manifestations.

Keywords: Brain metastases; Gastric cancer; Curative resection