Metastasis of Oropharyngeal Carcinoma to the Site of Percutaneous Endoscopic Gastrostomy: Literature Review

Abstract

Complications of percutaneous endoscopic gastrostomy (PEG) are relatively uncommon. PEG site metastases are iatrogenic complications of PEG tube placement. The literature search revealed only a few descriptions of tumor implantation at the PEG site. The patient is a 62-year-old male with a history of alcoholism and tobacco abuse. He was diagnosed with stage IV (T4 N2M0) squamous cell carcinoma (SCC) of the piriform recess. A PEG tube was placed and he underwent wide resection of aerodigestive tract. One year later, the patient mentioned a granulation tissue forming around the tube site. An en bloc resection of the abdominal wall was performed. The postoperative histopathological findings were in accordance with the diagnosis of SCC. Herein, an extremely rare case of metastasis of an oropharyngeal cancer at a PEG stoma is described. Multiple theories of metastatic spread have been proposed. The mean time to PEG site implantation was 8 months after insertion. In patients of whom the interval between PEG placement and diagnosis of metastasis was 1 year, Douglas et al concluded that hematogenous spread is less likely than direct implantation of cells. The exact mechanism of abdominal wall metastasis in our patient still remains unclear. In our case, the time to PEG site implantation was 1 year and lymph nodes were invaded before PEG placement (T4 N2M0). Metastatic cancer should be evoked when skin changes at the PEG site in patients with head-and-neck cancer.




J Curr Surg. 2014;4(2):46-48
doi: http://dx.doi.org/10.14740/jcs223w