核医学と放射線治療

Metastatic Implantation of Esophageal Cancer at PEG Tube Site: Case Report and Review of Literature

Abstract

Jenny Joseph, Judith Aaron, Johny K Joseph, Jose Tom, Bindu TG, Anuradha R and Jino Thomas

Percutaneous Endoscopic Gastrostomy (PEG) is a common procedure done in patients with Carcinoma Esophagus whose nutritional status is compromised due to the primary disease and treatment related side effects. A rare and serious complication of this procedure is the metastatic spread of tumour from the esophagus to the gastrostomy site. We discuss a case of 70-year-old lady with Stage IVA (T4bN0M0) Squamous cell carcinoma esophagus who underwent PEG insertion prior to radical radiation treatment. 9 months later, she presented with a painful, ulceroproliferative growth at stomal site. It was histopathologically proven to be a metastasis from the primary. Palliative radiation with a dose of 30 Gy in 10 fractions by 3D conformal technique was delivered and good clinical response wasachieved. However preventive methods such as surgical gastrostomy tube insertion procedures and delaying the timing of insertion of PEG tube to after commencing definitive treatment might help to decrease the risk. Positron Emission Tomography-Computed Tomography (PET/CT) scan is an effective tool for early detection of PEG site metastasis.