Salvage Embolization and Histologic Analysis of Gastric Cancer with Hemorrhagic Shock Using Spherical Embolic Material

Abstract

SummaryBackgroundIn a recent study, it was reported that transcatheter arterial embolization with spherical embolic material for life-threatening hemorrhages in various cancer patients was safe and effective. Calibrated microspheres are able to access distal regions of the target arteries, which results in the disappearance of tumor staining. However, there are few reports on the pathological behavior of EmboSpheres in gastric cancer specimens. In this case, we succeeded in salvage embolization for advanced gastric cancer with hemorrhagic shock using spherical embolic material. To our knowledge, this is the first report of a pathological evaluation of spherical embolic microspheres in a gastric cancer specimen.Case ReportA 70-year-old man with scirrhous gastric cancer was admitted to our hospital for staging laparoscopy. Unfortunately, he had a sudden onset of hematemesis and melena leading to hemorrhagic shock due to bleeding from the gastric cancer. While undergoing a rapid blood transfusion, he underwent emergent embolization to achieve hemostasis. The left gastric and right gastroepiploic arteries were embolized with spherical embolic material, and the patient survived. Two days later, the patient was able to undergo gastrectomy. A large number of microspheres were observed in areas of hemorrhage. The range and median diameter of the minor axis were 177–1048 μm and 281 μm, respectively.ConclusionsTranscatheter arterial embolization using spherical embolic material could become one of safe and effective options, especially when there is no extravasation or pseudoaneurysm but only tumor staining from the clinical and pathological point of view.

Acute Gastric Hemorrhage due to Gastric Cancer Eroding Into a Splenic Artery Pseudoaneurysm: Two Dangerously Rare Etiologies of Upper Gastrointestinal Bleeding

“…Based on review of current English literature, there has only been one other reported case of a patient presenting with a UGIB secondary to a ruptured SAP in the setting of an underlying gastric cancer [ 12 ]. In traditional bleeding gastric cancers, therapeutic intervention is usually prioritized in the following order: first endoscopic treatment, second transcatheter arterial embolization, and third emergent gastrectomy [ 13 ]. Although upper endoscopy has a high reported success rate in treating actively bleeding inoperable gastric cancers, its therapeutic utility is severely limited by profuse bleeding [ 11 ].…”

Hemosuccus pancreatitis due to a ruptured splenic artery pseudoaneurysm - diagnosis and endovascular management

“…Evidence of lymphadenopathy, omental caking and distant metastasis may also be seen [29]. Angiographic findings include a 'tumor blush' due to neovascularity, pseudoaneurysm formation and active bleeding [30]. Endoscopic findings range from a focal area of mucosal irregularity to a large mass with areas of ulceration and bleeding.…”