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      Distal Cholangiocarcinoma with Gastric Metastasis Mimicking Early Gastric Cancer

      case-report

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          Abstract

          We report an unusual case of distal cholangiocarcinoma with gastric metastasis mimicking early gastric cancer. A 67-year-old woman presented with a 4-month history of abdominal pain after eating. Computed tomography showed a malignant tumor of the common bile duct located just above the intrapancreatic segment, and endoscopy revealed a 2-cm, flat, elevated lesion with convergence of the surrounding folds, situated at the gastric angle. Based on the endoscopic biopsy results, an adenocarcinoma, thought to be an early gastric cancer, was diagnosed. The patient underwent Whipples's operation. Histopathological findings showed that the adenocarcinomatous tissue was clearly demarcated and infiltrated the gastric mucosa and submucosa, leaving the gastric superficial mucosa intact. Both tumors showed similar pathological features and were positive for cytokeratin (CK)-19 and CK-7. These finding suggest distal cholangiocarcinoma with gastric metastasis.

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          The implications of angiogenesis for the biology and therapy of cancer metastasis.

          James Ellis, ISAIAH FIDLER (1994)
          Article 0 comments Cited 118 times – based on 0 reviews     Review now
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            Panels of immunohistochemical markers help determine primary sites of metastatic adenocarcinoma.

            Jung Kim, Gyeong Hoon Kang, Hye Sun Lee … (2007)
            Although identification of the primary tumor in patients with metastatic adenocarcinoma has a profound clinical impact, diagnosing the organ of origin is frequently difficult. Because none of the individual immunohistochemical markers used for tissue identification are both site specific and site sensitive, multiple markers are needed to improve the prediction of primary sites. To develop an effective approach to immunohistochemically evaluate metastatic adenocarcinoma for the assignment of a likely primary site of origin. Expression profiles of CDX2, cytokeratin (CK) 7, CK20, thyroid transcription factor 1 (TTF-1), carcinoembryonic antigen (CEA), MUC2, MUC5AC, SMAD4, estrogen receptor (ER), and gross cystic disease fluid protein 15 (GCDFP-15) were generated in adenocarcinomas from 7 primary sites, followed by construction of a decision tree and design of multiple-marker panels. Expression of these markers was evaluated immunohistochemically in 314 primary adenocarcinomas (50 cases each of colorectal, gastric, lung, pancreatic, bile duct, and breast, and 14 cases of ovarian origin) using the tissue array method. Results were validated using 60 cases of metastatic adenocarcinoma with known primaries. Organ-specific immunostaining profiles using multiple markers provided high sensitivity, specificity, and positive predictive value in detecting primary adenocarcinomas, as follows: colorectal, TTF-1-/CDX2+/CK7-/CK20+ or TTF-1-/CDX2+/CK7-/CK20-/(CEA+ or MUC2+); ovarian, CK7+/MUC5AC+/TTF-1-/CDX2-/CEA-/GCDFP-15-; breast, GCDFP-15+/TTF-1-/CDX2-/CK7+/CK20- or ER+/ TTF-1-/CDX2-/CK20-/CEA-/MUC5AC-; lung, TTF-1+ or TTF-1-/CDX2-/CK7+/CK20-/GCDFP-15-/ER-/CEA-/ MUC5AC-; pancreaticobiliary, TTF-1-/CDX2-/CK7+/ CEA+/MUC5AC+; and stomach, TTF-1-/CDX2+/CK7+/ CK20-. Overall, these combined phenotypes correctly predicted the tester samples (metastatic adenocarcinomas with known primaries) in 75% of cases. Determination of tissue-specific immunostaining profiles is valuable in the diagnostic differentiation of metastatic adenocarcinomas from seven common primary sites and should help to correctly predict the organ of primary tumor origin.
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              Metastatic tumors to the stomach: clinical and endoscopic features.

              P. Donisi, Loredana Iannone, Giovanni Persico … (2006)
              To evaluate the clinical and endoscopic patterns in a large series of patients with metastatic tumors in the stomach. A total of 64 patients with gastric metastases from solid malignant tumors were retrospectively examined between 1990 and 2005. The clinicopathological findings were reviewed along with tumor characteristics such as endoscopic pattern, location, size and origin of the primary sites. Common indications for endoscopy were anemia, bleeding and epigastric pain. Metastases presented as solitary (62.5%) or multiple (37.5%) tumors were mainly located in the middle or upper third of stomach. The main primary metastatic tumors were from breast and lung cancer and malignant melanoma. As the prognosis of cancer patients has been improving gradually, gastrointestinal (GI) metastases will be encountered more often. Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient's clinical history are useful for correct diagnosis of gastric metastases.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Gut Liver
                Journal ID (publisher-id): GNL
                Title: Gut and Liver
                Publisher: The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Society of Pancreatobiliary Diseases
                ISSN (Print): 1976-2283
                ISSN (Electronic): 2005-1212
                Publication date (Print): September 2009
                Publication date (Electronic): 30 September 2009
                Volume: 3
                Issue: 3
                Pages: 222-225
                Affiliations
                [* ]Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
                [† ]Department of Pathology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
                Author notes
                Correspondence to: Byung Seok Lee. Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-280-7164, Fax: +82-42-254-4553, gie001@ 123456cnuh.co.kr
                Article
                DOI: 10.5009/gnl.2009.3.3.222
                PMC ID: 2852712
                PubMed ID: 20431751
                SO-VID: 3f4d6747-d08c-4b4f-b6c3-441727e956b1
                Copyright © Copyright © 2009 The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Society of Pancreatobiliary Diseases
                History
                Date received : 25 February 2009
                Date accepted : 28 June 2009
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: stomach,metastasis,cholangiocarcinoma
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: stomach, metastasis, cholangiocarcinoma

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