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Diffuse gastric metastases from salivary duct carcinoma
AT THE FOCAL POINT Massimo Raimondo, MD, Associate Editor for Focal Points
Diffuse gastric metastases from salivary duct carcinoma
A 64-year-old man underwent a right parotidectomy for a parotid gland tumor. Histologic examination revealed poorly differentiated adenocarcinoma with lymph node metastases, and the tumor was diagnosed as salivary duct carcinoma (SDC). Adjuvant chemotherapy was performed for 8 months until CT revealed no residual lesions of SDC. Thirteen months after the surgery, he underwent surveillance EGD and was referred to our hospital for scrutiny of the gastric lesions. Under EGD, thickened gastric folds in the greater curvature of the gastric corpus were discontinuously and ambiguously identified (A), and the surface of these lesions was reddish and coarse (B). Multiple reddish protrusions with central depression were also found in the gastric antrum (A). Examination of biopsy specimens from both thickened reddish folds and protrusions identified poorly differentiated adenocarcinoma (C). Immunohistochemical examination showed that the tumor cells were positive for CK903, Her2, AE1/AE2, androgen receptor
www.giejournal.org
(C, inset), and GCDFP15 and were negative for b-catenin. The features were the same as that of resected SDC. We thus diagnosed the lesions as multiple gastric metastases of SDC. Subsequent abdominal CT further demonstrated multiple liver metastases. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Yuji Maehata, MD, PhD, Department of Medicine and Clinical Science, Yoshifumi Hori, MD, Minako Hirahashi, MD, PhD, Hidetaka Yamamoto, MD, PhD, Department of Anatomic Pathology, Motohiro Esaki, MD, PhD, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan http://dx.doi.org/10.1016/j.gie.2017.05.027
Volume
-,
No.
-
: 2017 GASTROINTESTINAL ENDOSCOPY 1
At the Focal Point
Commentary Although most gastroenterologists think little about, and will likely never encounter, salivary gland adenocarcinoma, it is a rare but important clinical entity among so-called head and neck cancers. Salivary gland tumors can arise from the major or minor salivary glands, including the submandibular, sublingual, or parotid glands and the oral and paranasal submucosal glands. The malignancies can recur locally or distantly after initial resection, with most metastases being found in the bones, the liver, or the lung. The rarity of these lesions has limited their study, and the optimal chemotherapeutic regimen for metastatic SGD has not been identified yet. The authors herein describe a case of metastatic salivary gland tumor to the stomach, something that has been seen only a few times. These lesions in the stomach can be asymptomatic or can present with bleeding, which can at times be fatal. Douglas G. Adler, MD, FASGE GIE Associate Editor University of Utah School of Medicine Salt Lake City, Utah Massimo Raimondo, MD Associate Editor for Focal Points
2 GASTROINTESTINAL ENDOSCOPY Volume
-,
No.
-
: 2017
www.giejournal.org
Diffuse gastric metastases from salivary duct carcinoma
A 64-year-old man underwent a right parotidectomy for a parotid gland tumor. Histologic examination revealed poorly differentiated adenocarcinoma with lymph node metastases, and the tumor was diagnosed as salivary duct carcinoma (SDC). Adjuvant chemotherapy was performed for 8 months until CT revealed no residual lesions of SDC. Thirteen months after the surgery, he underwent surveillance EGD and was referred to our hospital for scrutiny of the gastric lesions. Under EGD, thickened gastric folds in the greater curvature of the gastric corpus were discontinuously and ambiguously identified (A), and the surface of these lesions was reddish and coarse (B). Multiple reddish protrusions with central depression were also found in the gastric antrum (A). Examination of biopsy specimens from both thickened reddish folds and protrusions identified poorly differentiated adenocarcinoma (C). Immunohistochemical examination showed that the tumor cells were positive for CK903, Her2, AE1/AE2, androgen receptor
www.giejournal.org
(C, inset), and GCDFP15 and were negative for b-catenin. The features were the same as that of resected SDC. We thus diagnosed the lesions as multiple gastric metastases of SDC. Subsequent abdominal CT further demonstrated multiple liver metastases. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Yuji Maehata, MD, PhD, Department of Medicine and Clinical Science, Yoshifumi Hori, MD, Minako Hirahashi, MD, PhD, Hidetaka Yamamoto, MD, PhD, Department of Anatomic Pathology, Motohiro Esaki, MD, PhD, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan http://dx.doi.org/10.1016/j.gie.2017.05.027
Volume
-,
No.
-
: 2017 GASTROINTESTINAL ENDOSCOPY 1
At the Focal Point
Commentary Although most gastroenterologists think little about, and will likely never encounter, salivary gland adenocarcinoma, it is a rare but important clinical entity among so-called head and neck cancers. Salivary gland tumors can arise from the major or minor salivary glands, including the submandibular, sublingual, or parotid glands and the oral and paranasal submucosal glands. The malignancies can recur locally or distantly after initial resection, with most metastases being found in the bones, the liver, or the lung. The rarity of these lesions has limited their study, and the optimal chemotherapeutic regimen for metastatic SGD has not been identified yet. The authors herein describe a case of metastatic salivary gland tumor to the stomach, something that has been seen only a few times. These lesions in the stomach can be asymptomatic or can present with bleeding, which can at times be fatal. Douglas G. Adler, MD, FASGE GIE Associate Editor University of Utah School of Medicine Salt Lake City, Utah Massimo Raimondo, MD Associate Editor for Focal Points
2 GASTROINTESTINAL ENDOSCOPY Volume
-,
No.
-
: 2017
www.giejournal.org