{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:28:29Z","timestamp":1786512509518,"version":"build-2736575974"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Gastric adenocarcinoma simultaneously metastasizing to the skin and pineal gland represents an extraordinarily rare clinical manifestation. Pineal metastases account for less than 1% of all adult intracranial tumors and seldom originate from gastrointestinal primary lesions, and this atypical metastatic combination frequently results in delayed diagnosis and complicated clinical decision-making. Distinct molecular profiles between primary and metastatic lesions create additional obstacles to personalized treatment, and relevant standardized management strategies for such rare cases have not been well established. We describe a 43-year-old woman with advanced gastric adenocarcinoma complicated by synchronous cutaneous and pineal metastases. Pathological evaluation confirmed the gastric origin of the cutaneous lesions, while the pineal lesion was presumptively classified\u200b as metastatic based on molecular concordance and clinical context. Guided by variable biomarker status across metastatic sites, sequential individualized targeted regimens were delivered, yielding sustained disease stabilization and satisfactory long-term survival. This case supplements clinical data on rare distant metastatic patterns of gastric cancer and highlights that repeated multi-site genetic testing is essential to formulate precise therapeutic plans for heterogeneous advanced gastrointestinal malignancies.<\/jats:p>","DOI":"10.3389\/fonc.2026.1924850","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:45:24Z","timestamp":1786509924000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Synchronous cutaneous and pineal metastases from gastric adenocarcinoma\u2014inter-lesion biomarker heterogeneity and multi-line targeted therapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Qing","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, The First Hospital of China Medical University","place":["Shenyang, 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