| Abstract|| |
As cervical metastases in esophagogastric junction cancer are extremely rare, the authors herein report a case. A 63-year-old woman presented with dysphagia since 6 months. Diagnostic endoscopy showed that the tumor was located at the esophagogastric junction and histopathological diagnosis of adenocarcinoma was offered. A subtotal gastrectomy was performed. Histopathological diagnosis was moderately differentiated adenocarcinoma, invading upto the serosa with metastases to perigastric nodes. The patient received chemotherapy of cisplatin and fluorouracil for one cycle and oral capecitabine for two cycles. Two years later, the patient presented with vaginal bleeding and magnetic resonance imaging of pelvis revealed a tumor of the cervix. Histopathological impression of the tumor was metastatic cervical adenocarcinoma and immunohistochemistry showed the tumor was cytokeratin, villin, and CDX2 were positive and cytokeratin 20, CA125, and CA199 were negative. The immunohistochemical profile was the same as that of primary.
Keywords: Cervix, esophagogastric cancer, immunohistochemistry, metastasis
|How to cite this article:|
Cai Z, Shu X, Li J, Yang J. Cervical metastasis of esophagogastric junction cancer. Indian J Pathol Microbiol 2012;55:560-2
| Introduction|| |
Gastric cancer usually spreads either by direct extension, via the lymphatics and vascular system or by peritoneal dissemination. Common metastatic sites of gastric cancer are liver, lung, ovaries, and bone.  However, cervical metastases of esophagogastric junction cancer are very rare.
| Case Report|| |
As cervical metastases in esophagogastric junction cancer are extremely rare, we report a case. A 63-year-old woman presented with dysphagia over 6 months. Diagnostic endoscopy was performed to determine the location of lesion and biopsy samples from suspicious areas were studied. Endoscopy showed that the tumor was located at the esophagogastric junction and histopathological diagnosis of adenocarcinoma was offered. A subtotal gastrectomy was performed for this patient. There was an ulcer measuring 6 × 5 × 0.5 cm at the esophagogastric junction. Histopathological diagnosis was moderately differentiated adenocarcinoma [Figure 1]. The tumor invaded serosal layer of stomach and metastasized to station 1, 2, 3 perigastric lymph nodes. Surgical margins were negative. After surgery, this patient received a combination chemotherapy of cisplatin and fluorouracil for one cycle. Because of severe gastrointestinal adverse effects, the chemotherapy regimen was replaced with oral capecitabine for two cycles. Subsequently, the patient was followed-up regularly. Two years later, the patient presented with vaginal bleeding, magnetic resonance imaging examination of pelvis revealed a tumor over the cervix [Figure 2]. Inspection revealed a tumor of 2 cm in size. Histopathological impression of the tumor was metastatic cervical adenocarcinoma and immunohistochemical analysis showed that cytokeratin, villin, and CDX2 were positive and cytokeratin 20, CA125, and CA199 were negative [Figure 3]. The immunohistochemical results were the same as the gastric tumor. Hence, a diagnosis of cervical metastasis of esophagogastric junction cancer was made.
|Figure 1: Photomicrograph of primary tumor from esophagogastic junction showing features of adenocarcinoma (H and E, ×200)|
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|Figure 3: Immunohistochemistry of metastatic tumor, Villin(+), CK7(+), CDX2(+), CK20(-), CA199(-), and CA125(-) (IHC,×40)|
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| Discussion|| |
Metastases of gastric cancer may be found at the time of diagnosis or at some intervals after gastrectomy.  About 18% of patients with gastric cancer will eventually develop metastasis after gastrectomy.  In 1960, Queinnec and Queinnec  first reported cervical metastasis of gastric cancer. Imachi et al. reported 16 cases of metastatic cervical adenocarcinoma of gastric cancer. Mastsushita et al. presented a 50-year-old woman complaining of increasing right flank pain; computed tomography scan demonstrated an enlarged uterus with right-sided hydronephrosis and hydroureter. She was considered to have a stage IIIB cervical adenocarcinoma. Histopathology from biopsies of the cervix showed poorly differentiated adenocarcinoma infiltrating around the normal endocervical glands. A metastasis from the gastrointestinal tract was suspected. Subsequently, the patient underwent gastroscopy inspection and was found to have Borrmann type IV gastric cancer. Schoeneich  had reported stomach metastasis of cervix cancer. Takahashii et al. reported cervical lymph nodes metastases of gastric cancer.
Based on the above review, gastric cancer and cervical cancer can spread to each other sites, but the metastatic path is still a challenge to clinician. Matsushita et al. reported that lymph vessel permeation was found in both the primary lesion of the stomach and the metastatic lesion of the cervix. Hence, similar to Krukenberg tumor of the ovary, we may surmise that lymphatic dissemination would be regarded as the metastatic route.
It seems that chemotherapy is the only treatment method in this condition. Kinoshita et al. had reported a case of advanced gastric cancer with cervical lymph nodes metastases, and the patient was successfully treated with S-1, cisplatin, and lentinan combination chemotherapy. Sugishita et al. had reported a case of advanced gastric cancer with cervical lymph node metastases responded to the combination therapy of S-1, cisplatin, and docetaxel. In this case, this patient could not tolerate chemotherapy because of severe toxicity, so we performed palliative radiotherapy for this patient. A radiation (4600 cGY) was delivered in 23 fractions, 5 days per week, to the tumor bed and regional lymph nodes. After radiotherapy, evaluation of cervical target lesion showed partial response according to the response evaluation criteria in solid tumor.  Although the radiotherapy efficacy for this patient is partial response, more clinical trials were needed to generalize this treatment recommendation to other patients in the same condition.
| Acknowledgment|| |
Author are very grateful to Wentao Zhang, Zhen Liu, and Ke Hu in modifying this paper.
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Department of Oncology, The First Affiliated Hospital, Yangtze University, Jingzhou, Hubei
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]