Rarely a malignancy may metastasize to a percutaneous endoscopic gastrostomy (PEG) site. Early diagnosis can improve the patient's outcome.
Clinical features:
(1) The patient has a history of cancer, usually a head and neck or esophageal cancer.
(2) A gastrostrosomy site is placed to aid nutritional support.
(3) A hard nodule develops at the ostomy site which may ulcerate.
(4) Biopsy of the nodule shows a cancer that is similar to the previous cancer.
Mechansim of tumor spread:
(1) locoregional spread
(2) hematogenous (more likely, associated with the increased vascularity at the site)
Differential diagnosis:
(1) inflammatory metaplasia
(2) secondary carcinoma due to long-standing inflammation of the ostomy
Early diagnosis and resection of the tumor can be associated with a favorable outcome (Fonseca et al, 2015).
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Specialty: Hematology Oncology, Surgery, general