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This open-access case report describes a 48-year-old woman with persistent musculoskeletal pain and diplopia. Workup identified a right orbital mass, gastric antral thickening, peritoneal carcinomatosis, and multiple soft tissue metastases, with biopsy confirming high-grade poorly differentiated, microsatellite-stable adenocarcinoma that was HER2/PD-L1 negative.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/advanced-gastric-adenocarcinoma-presenting-with-shoulder-pain-and-diplopia/433223/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/advanced-gastric-adenocarcinoma-presenting-with-shoulder-pain-and-diplopia/433223.png","ImageObject",300,407,{"name":92,"@type":93},"PakDamar76","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why can gastric adenocarcinoma present without gastrointestinal symptoms in this case?","Question",{"text":112,"@type":113},"The report notes that, in rare situations, patients may first show signs of distant metastases rather than typical gastrointestinal complaints, as occurred here with musculoskeletal pain and diplopia.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What key diagnostic findings confirmed the cause of symptoms?",{"text":117,"@type":113},"Cross-sectional evaluation identified a right orbital mass and gastric antral thickening with peritoneal carcinomatosis and multiple soft tissue metastases. Biopsy of the gastric lesion confirmed high-grade, poorly differentiated adenocarcinoma with microsatellite stability and negative HER2 and PD-L1 expression.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the patient treated after diagnosis and symptom evolution?",{"text":121,"@type":113},"The patient received palliative stereotactic radiation therapy to the orbit and systemic chemotherapy with FOLFOX. Symptoms initially improved, but subsequent complications occurred, leading to a transition to comfort-focused care.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},433223,1790779776,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090893057,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review began 08/09/2025  \nReview ended 11/22/2025  \nPublished 12/03/2025  \n© Copyright 2025  \nGandarilla et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98409  \nOpen Access Case Report  \nAdvanced Gastric Adenocarcinoma Presenting With Shoulder Pain and Diplopia  \nOmar Gandarilla 1 , Aashi Saraf 1, Uqba Khan 2, Brandon Swed 3  \n1. Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, New York, USA 2. Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, USA 3. Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, New York, USA  \nCorresponding author: Omar Gandarilla, [omg4001@med.cornell.edu](omg4001@med.cornell.edu)  \nAbstract  \nGastric adenocarcinoma is a leading cause of cancer-related mortality worldwide, with many cases diagnosed at an advanced stage. While liver, peritoneal, and lymphatic involvement are common, metastases to soft tissue and orbital structures are exceedingly rare and may present with non-specific symptoms that mimic benign conditions. We report the case of a 48-year-old woman who presented with persistent musculoskeletal pain and diplopia. Initial symptoms were attributed to sciatica, but further evaluation revealed a right orbital mass, gastric antral thickening, peritoneal carcinomatosis, and multiple soft tissue metastases. Biopsy of the gastric lesion confirmed high-grade, poorly differentiated adenocarcinoma, microsatellite stable, and negative for HER2 and PD-L1 expression. The patient received palliative stereotactic radiation therapy to the orbit and systemic chemotherapy with FOLFOX. Although her symptoms initially improved, she experienced multiple complications, including bacteremia, gastrointestinal bleeding, and thromboembolic events, ultimately leading to a transition to comfort-focused care. This case highlights the importance of maintaining a broad differential diagnosis in patients with persistent or atypical symptoms and underscores the need for early imaging and multidisciplinary evaluation. Recognition of rare metastatic patterns in gastric cancer is essential to avoid diagnostic delaysand initiate appropriate treatment strategies that can improve quality of life, even in the setting of advanced disease.  \nCategories: Oncology, Gastroenterology  \nKeywords: advanced gastric cancer, diplopia, muscle metastasis, orbital metastasis, soft tissue metastasis  \nIntroduction  \nGastric adenocarcinoma remains a major contributor to cancer-related mortality worldwide, with approximately half of patients presenting with advanced disease at diagnosis [1] . Gastric adenocarcinomas are typically sporadic, with a rare genetic etiology in 5%-10% . Common risk factors include Helicobacter pylori infection, Epstein-Barr virus, high-salt foods, N-nitroso compounds, smoking, high consumption of smoked foods, and chronic gastroesophageal reflux. Typically, patients with gastric adenocarcinoma present initially with gastrointestinal symptoms such as indigestion, nausea, and vomiting. As the cancer progresses, symptoms include more invasive symptoms such as hematemesis, hematochezia, ascites, or palpable masses. Metastatic gastric cancer has a few well-known physical exam signs, including Virchow’s node (left supraclavicular lymphadenopathy), the Sister Mary Joseph nodule (periumbilical lymphadenopathy), and the Irish node. Paraneoplastic manifestations, including seborrheic keratosis, are occasionally observed [2] . Diagnosis is usually established by esophagogastroduodenoscopy with biopsy, along with staging CT scans. Histopathologic evaluation commonly identifies either intestinal-type or diffuse-type adenocarcinoma. In patients who are surgical candidates, perioperative chemotherapy is typically offered. In patients with advanced and","cbCaide1ySzkxRGL","https://ap.wps.com/l/cbCaide1ySzkxRGL","pdf",1817990,"English","# Abstract\n# Introduction\n# Case Presentation\n## Clinical presentation and initial evaluation\n## Diagnostic imaging and findings\n# How to cite this article","[{\"question\":\"Why can gastric adenocarcinoma present without gastrointestinal symptoms in this case?\",\"answer\":\"The report notes that, in rare situations, patients may first show signs of distant metastases rather than typical gastrointestinal complaints, as occurred here with musculoskeletal pain and diplopia.\"},{\"question\":\"What key diagnostic findings confirmed the cause of symptoms?\",\"answer\":\"Cross-sectional evaluation identified a right orbital mass and gastric antral thickening with peritoneal carcinomatosis and multiple soft tissue metastases. Biopsy of the gastric lesion confirmed high-grade, poorly differentiated adenocarcinoma with microsatellite stability and negative HER2 and PD-L1 expression.\"},{\"question\":\"How was the patient treated after diagnosis and symptom evolution?\",\"answer\":\"The patient received palliative stereotactic radiation therapy to the orbit and systemic chemotherapy with FOLFOX. Symptoms initially improved, but subsequent complications occurred, leading to a transition to comfort-focused care.\"}]","Advanced Gastric Adenocarcinoma Presenting With Shoulder Pain and Diplopia | PDF",1790663206,13]