Gastrointestinal: Abdominal wall metastasis after percutaneous endoscopic gastrostomy

Abstract

Gastrointestinal: Abdominal wall metastasis after percutaneous endoscopic gastrostomyA 53-year-old woman was referred for evaluation with recurrent carcinoma of the right piriform fossa. She had been previously treated by radiotherapy. Radical surgery was undertaken that included a total laryngopharyngectomy with reconstruction of the pharynx using a flap from the antero-lateral aspect of the left thigh. During the operation, percutaneous endoscopic gastrostomy was performed for post-operative feeding. The resected specimen revealed squamous cell carcinoma of moderate differentiation with infiltration of the tumor into the thyroid gland and into the esophageal wall. All surgical margins were free of tumor. After 5 months, she was noted to have a friable and bleeding mass at the gastrostomy site. The mass had raised margins and was approximately 5 cm in diameter (Fig. 1). Biopsies revealed squamous cell carcinoma of moderate differentiation (Fig. 2). Biopsies of a recurrent neck swelling also showed squamous cell carcinoma. She declined further therapy and is currently being treated symptomatically.Carcinomas of the head and neck are common neoplasms in many countries. Typical sites for metastases include lung, liver and bone. Surgical treatment for these neoplasms often involves prolonged avoidance of oral food and fluids and, because of this, feeding through a gastrostomy tube is widely used during the post-operative period. A metastasis in the abdominal wall at the site of the gastrostomy tube was first reported by Drs Preyer and Thul in 1989. Since that time, an additional 50 cases have been reported with an estimated frequency ranging from 0.5% to 1%. Clinically, metastases may present as non-healing peristomal ulceration, recurrent stomal bleeding, an exophytic peristomal mass or a deep abdominal wall mass. While direct spread of the neoplasm during the endoscopic procedure appears to be the most likely cause for abdominal wall metastases, other hypotheses have been suggested including hematogenous and lymphatic spread to the abdominal wall. The development of a gastrostomy metastasis with carcinoma of the head and neck is a poor prognostic feature. Such patients have a mean survival of 7 months and 1 year survival of <5%.

Tumor implantation following percutaneous endoscopic gastrostomy insertion for head and neck and oesophageal cancer: Review of the literature

“…Details of case reports are tabulated in Table . A series of earlier cases reviewed in detail by Coletti is included (but excluding a possible duplicate report).…”

Head and neck cancer PEG site metastases: Association with PEG placement method

“…When available, the method of PEG placement for each case was documented. A total of 62 cases were identified (Table ).…”

“…13,14 Patients with metastases to the gastrostomy site have a mean survival of 7 months and 1 year survival rate of less than 5%. 15 Additionally, metastases to the PEG site are often accompanied by additional distant metastases, a factor that strongly supports an aggressive tumor type and the disseminated nature of the disease, as opposed to a local phenomenon. 16 This report describes an abdominal wall metastasis secondary to two separate PEG placements in a patient with advanced squamous cell carcinoma at the base of the tongue and provides a comprehensive review and analysis Mary K. Montes de Oca, Anthony Nye, and Caroline Porter contributed equally to this work.…”

“…This rare complication is associated with a poor prognosis, despite aggressive treatment . Patients with metastases to the gastrostomy site have a mean survival of 7 months and 1 year survival rate of less than 5% . Additionally, metastases to the PEG site are often accompanied by additional distant metastases, a factor that strongly supports an aggressive tumor type and the disseminated nature of the disease, as opposed to a local phenomenon .…”

Palliative concurrent chemoradiation for gastrostomy site metastasis

“…It was rst reported by Preyer and ul in 1989, 4 and the frequency is estimated to range from 0.5%-1%. 5 In this article, we report a case of PEG site metastasis with meaningful response to concurrent chemoradiation. We also discuss the common PEG insertion methods and the risks of metastasis, and review prevention and treatment strategies.…”