Metastasis to a Percutaneous Endoscopic Gastrostomy (PEG) Site

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).