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CASE REPORT  
Year : 2012  |  Volume : 55  |  Issue : 4  |  Page : 560-562
Cervical metastasis of esophagogastric junction cancer


Department of Oncology, The First Affiliated Hospital, Yangtze University, Jingzhou, Hubei, China

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Date of Web Publication4-Mar-2013
 

   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

How to cite this URL:
Cai Z, Shu X, Li J, Yang J. Cervical metastasis of esophagogastric junction cancer. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Sep 22];55:560-2. Available from: http://www.ijpmonline.org/text.asp?2012/55/4/560/107820



   Introduction Top


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. [1] However, cervical metastases of esophagogastric junction cancer are very rare.


   Case Report Top


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 2: Pelvic magnetic resonance imaging of metastatic cervix tumor

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Figure 3: Immunohistochemistry of metastatic tumor, Villin(+), CK7(+), CDX2(+), CK20(-), CA199(-), and CA125(-) (IHC,×40)

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   Discussion Top


Metastases of gastric cancer may be found at the time of diagnosis or at some intervals after gastrectomy. [2] About 18% of patients with gastric cancer will eventually develop metastasis after gastrectomy. [2] In 1960, Queinnec and Queinnec [3] first reported cervical metastasis of gastric cancer. Imachi et al.[4] reported 16 cases of metastatic cervical adenocarcinoma of gastric cancer. Mastsushita et al.[5] 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 [6] had reported stomach metastasis of cervix cancer. Takahashii et al.[7] 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.[5] 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.[8] 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.[9] 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. [10] 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 Top


Author are very grateful to Wentao Zhang, Zhen Liu, and Ke Hu in modifying this paper.

 
   References Top

1.Smalley SR, Gunderson L, Tepper J, Martenson JA Jr, Minsky B, Willett C, et al. Gastric surgical adjuvant radiotherapy consensus report: Rationale and treatment implementation. Int J Radiat Oncol Biol Phys 2002;52:283-93.  Back to cited text no. 1
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2.Sougioultzis S, Syrios J, Xynos ID, Bovaretos N, Kosmas C, Sarantonis J, et al. Palliative gastrectomy and other factors affecting overall survival in stage IV gastric adenocarcinoma patients receiving chemotherapy: A retrospective analysis. Eur J Surg Oncol 2011;37:312-8.  Back to cited text no. 2
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3.Queinnec A, Queininec J. Cervico-uterine metastasis of a gastric cancer. Mem Acad Chir (Paris) 1960;86:789-92.  Back to cited text no. 3
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4.Imachi M, Tsukamoto N, Amagase H, Shigematsu T, Amada S, Nakano H. Metastatic adenocarcinoma to the uterine cervix from gastric cancer. A clinicopathologic analysis of 16 cases. Cancer 1993;71:3472-7.  Back to cited text no. 4
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5.Matsushita H, Fukase M, Takayanagi T, Ikarashi H. Metastatic gastric cancer mimicking an advanced cervical cancer: A case report. Eur J Gynaecol Oncol 2011;32:199-200.  Back to cited text no. 5
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6.Schoeneich R. Grid irradiation of a stomach metastasis from a cervix uteri carcinoma, with a report on successful, roentgen therapy of 6 further metastases in the same patient. Strahlentherapie 1959;110:110-5.  Back to cited text no. 6
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7.Takashima T, Nakata B, Hatama M, Nomura S, Komoto M, Ishikawa T, et al. Gastric cancer with cervical lymph node metastasis as the first presentation: Report of a case. Int Surg 2008;93:295-9.  Back to cited text no. 7
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8.Kinoshita K, Kondo K, Watanabe K. A case of advanced gastric cancer with distant lymph node metastases in cervical, supraclavicular and superior mediastinum successfully treated with S-1/cisplatin (CDDP)/lentinan combination chemotherapy. Gan To Kagaku Ryoho 2010;37:707-10.  Back to cited text no. 8
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9.Sugishita H, Ishida N, Yoshida M, Sato K, Doi T, Horiuchi A, et al. A case of cervical lymph node recurrence of advanced gastric cancer responding to combination therapy of S-1, CDDP and docetaxel. Gan To Kagaku Ryoho 2010;37:1385-8.  Back to cited text no. 9
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10.Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47.  Back to cited text no. 10
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Correspondence Address:
Jiyuan Yang
Department of Oncology, The First Affiliated Hospital, Yangtze University, Jingzhou, Hubei
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.107820

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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1 Cisplatin/fluorouracil
Reactions Weekly. 2013; 1469(1): 16
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    Abstract
   Introduction
   Case Report
   Discussion
   Acknowledgment
    References
    Article Figures

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