CASE REPORT – OPEN ACCESS International Journal of Surgery Case Reports 23 (2016) 36–39
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International Journal of Surgery Case Reports journal homepage: www.casereports.com
Gastric metastasis from salivary duct carcinoma mimicking primary gastric cancer Kanefumi Yamashita a,∗ , Shinsuke Takeno a , Satoshi Nimura b , Yoshikazu Sugiyama c , Takayuki Sueta c , Kenji Maki a , Yoshiyuki Kayashima d , Hironari Shiwaku a , Daisuke Kato a , Tatsuya Hashimoto a , Takamitsu Sasaki a , Yuichi Yamashita a a
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan Department of Pathology, Fukuoka University Faculty of Medicine, Fukuoka, Japan c Department of Otolaryngology, Fukuoka University Faculty of Medicine, Fukuoka, Japan d Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan b
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Article history: Received 17 March 2016 Received in revised form 2 April 2016 Accepted 2 April 2016 Available online 7 April 2016 Keywords: Gastric metastasis Salivary duct carcinoma Salivary gland neoplasms
a b s t r a c t INTRODUCTION: We present a very rare case of gastric metastasis mimicking primary gastric cancer in a patient who had undergone surgery for salivary duct carcinoma. PRESENTATION OF CASE: A 67-year-old man had been diagnosed as having right parotid cancer and had undergone a right parotidectomy and lymph node dissection. The histological diagnosis was salivary duct carcinoma. One year after the surgery, a positron emission tomography–computed tomography scan using fluorodeoxyglucose (FDG) revealed an abnormal uptake of FDG in the left cervical, mediastinal, paraaortic, and cardiac lymph nodes; stomach; and pancreas. On gastroduodenoscopy, there was a huge, easily bleeding ulcer mimicking primary gastric cancer at the upper body of the stomach. Biopsy revealed poorly differentiated adenocarcinoma. Therefore, we were unable to differentiate between the primary gastric cancer and the metastatic tumor using gastroduodenoscopy and biopsy. Because of the uncontrollable bleeding from the gastric cancer, we performed an emergency palliative total gastrectomy. On histological examination, the gastric lesion was found to be metastatic carcinoma originating from the salivary duct carcinoma. DISCUSSION: In the presented case, we could not diagnose the gastric metastasis originating from the salivary duct carcinoma even by endoscopic biopsy. This is because the histological appearance of salivary duct carcinoma is similar to that of high-grade adenocarcinoma, thus, resembling primary gastric cancer. CONCLUSION: When we perform endoscopic examination of patients with malignant neoplasias, a possibility of metastatic gastric cancer should be taken into consideration. © 2016 Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction There are many histological types of salivary gland neoplasms. They include benign and malignant tumors of epithelial, mesenchymal, and lymphoid origin. The 2005 World Health Organization Classification of salivary gland tumors is complex and includes 10 benign and 23 malignant entities of epithelial origin [1]. Salivary gland malignancies have an estimated incidence of 0.5–2.5 per 100,000 individuals [2]. Among the malignancies, salivary duct carcinoma is characterized by an aggressive behavior, early metastases, local recurrence, and a high mortality rate [3] and con-
Abbreviations: FDG, fluorodeoxyglucose; CT, computed tomography. ∗ Corresponding author at: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan. E-mail address: [email protected] (K. Yamashita).
stitutes
Contents lists available at ScienceDirect
International Journal of Surgery Case Reports journal homepage: www.casereports.com
Gastric metastasis from salivary duct carcinoma mimicking primary gastric cancer Kanefumi Yamashita a,∗ , Shinsuke Takeno a , Satoshi Nimura b , Yoshikazu Sugiyama c , Takayuki Sueta c , Kenji Maki a , Yoshiyuki Kayashima d , Hironari Shiwaku a , Daisuke Kato a , Tatsuya Hashimoto a , Takamitsu Sasaki a , Yuichi Yamashita a a
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan Department of Pathology, Fukuoka University Faculty of Medicine, Fukuoka, Japan c Department of Otolaryngology, Fukuoka University Faculty of Medicine, Fukuoka, Japan d Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan b
a r t i c l e
i n f o
Article history: Received 17 March 2016 Received in revised form 2 April 2016 Accepted 2 April 2016 Available online 7 April 2016 Keywords: Gastric metastasis Salivary duct carcinoma Salivary gland neoplasms
a b s t r a c t INTRODUCTION: We present a very rare case of gastric metastasis mimicking primary gastric cancer in a patient who had undergone surgery for salivary duct carcinoma. PRESENTATION OF CASE: A 67-year-old man had been diagnosed as having right parotid cancer and had undergone a right parotidectomy and lymph node dissection. The histological diagnosis was salivary duct carcinoma. One year after the surgery, a positron emission tomography–computed tomography scan using fluorodeoxyglucose (FDG) revealed an abnormal uptake of FDG in the left cervical, mediastinal, paraaortic, and cardiac lymph nodes; stomach; and pancreas. On gastroduodenoscopy, there was a huge, easily bleeding ulcer mimicking primary gastric cancer at the upper body of the stomach. Biopsy revealed poorly differentiated adenocarcinoma. Therefore, we were unable to differentiate between the primary gastric cancer and the metastatic tumor using gastroduodenoscopy and biopsy. Because of the uncontrollable bleeding from the gastric cancer, we performed an emergency palliative total gastrectomy. On histological examination, the gastric lesion was found to be metastatic carcinoma originating from the salivary duct carcinoma. DISCUSSION: In the presented case, we could not diagnose the gastric metastasis originating from the salivary duct carcinoma even by endoscopic biopsy. This is because the histological appearance of salivary duct carcinoma is similar to that of high-grade adenocarcinoma, thus, resembling primary gastric cancer. CONCLUSION: When we perform endoscopic examination of patients with malignant neoplasias, a possibility of metastatic gastric cancer should be taken into consideration. © 2016 Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction There are many histological types of salivary gland neoplasms. They include benign and malignant tumors of epithelial, mesenchymal, and lymphoid origin. The 2005 World Health Organization Classification of salivary gland tumors is complex and includes 10 benign and 23 malignant entities of epithelial origin [1]. Salivary gland malignancies have an estimated incidence of 0.5–2.5 per 100,000 individuals [2]. Among the malignancies, salivary duct carcinoma is characterized by an aggressive behavior, early metastases, local recurrence, and a high mortality rate [3] and con-
Abbreviations: FDG, fluorodeoxyglucose; CT, computed tomography. ∗ Corresponding author at: Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Nanakuma 7-45-1, Jonan-ku, Fukuoka 814-0180, Japan. E-mail address: [email protected] (K. Yamashita).
stitutes
