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Gastrocolic fistula due to a metastatic marginal ulcer from carcinoma of the cervix
International Journal of Gynecology & Obstetrics 47 (1994) 173-174
Letter to the editor
Gastrocolic fistula due to a metastatic marginal ulcer from . carcinoma of the cervix J.-M. Chiang*, J.Y. Wang Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan, China
Received 21 April 1994; revision received I5 May 1994; accepted 3 June 1994
Keywords:
Gastrocolic
fistula; Cervical
cancer; Gastrointestinal
We present a case of squamous cell cancer of the uterine cervix with solitary distant gastrointestinal metastases 4 years after treatment. A 60-year-old Chinese female was admitted to hospital for nausea, anorexia, postprandial vomiting and watery diarrhea lasting 1 month. Five years earlier she had been diagnosed with chronic duodenal ulcer with pyloric obstruction and treated by subtotal gastrectomy and BillrothII reconstruction. Four years earlier she had been diagnosed with stage-IIb squamous cell cancer of the uterine cervix and was treated with irradiation. She tolerated the treatment well and became free of local disease. On admission she was pale and had evidence of weight loss (4-5 kg/month). Gynecologic examination did not reveal any local recurrence. Fiber optic upper gastrointestinal endoscopy demonstrated a marginal ulcer in the gastrojejunostomy. A barium enema study demonstrated barium from
* Corresponding author, Tel.: (03) 3281200, Ext. 2101; Fax: (03) 3284239. 0020.7292/94/$07.00 0 1994 International SSDI 0020-7292(94)02173-V
metastasis
the colon to the stomach and down to the small bowel, a filling defect over the transverse colon and no visible barium filling of the ascending colon and cecum (Fig. 1). The chest posterior-anterior (PA) film and routine laboratory parameters were within normal limits except for the presence of anemia (Hb = 75 g/dl) and elevated carcinoembryonic antigen level (18.9 &ml). At laparotomy, an indurated mass was found in the previous gastrojejunostomy site fused with the transverse colon. It was resected and revision of the gastrojejunostomy was performed. The postoperative course was relatively smooth and the patient was discharged and followed up for 1 year without evidence of recurrence. Pathological examination of the specimen demonstrated a segment of gastrojejunostomy and a segment of colon that had fused together. Microscopic section showed an ulceration at the junction of the stomach and jejunum which had perforated into the colon. A moderately differentiated squamous cell carcinoma was found with extensive infiltration at the site of the gastrojejunostomy and invasion through muscle layer to the serosa. Lym-
Federation of Gynecology and Obstetrics
174
Letters to the editor/W.
J. Gynecol. Obstet. 47 (1994) 173-174
phatic permeation and perineural invasion were also noted. Solitary gastrointestinal metastasis secondary to cervical carcinoma is rare [ 11. Cervical carcinoma spreads primarily by local extension and lymphatic spread [2]. Distant metastases usually indicate an advanced stage and combine with multiple sites of metastasis [3]. We could, however, find no reports in the literature of such solitary metastasis in gastrojejunostomy presenting as enterocolic tistula and gastric outlet obstruction associated with such an apparently healthy cervix. References VI Caramella E, Bruneton JN, Roux P, Aubanel D, Lecomte P: Metastases of the digestive tract. Report of 77 cases and review of the literature. Eur J Radio1 3: 331, 1983. 121Menuck LS, Amberg JR: Metastatic disease involving the stomach. Am J Dig Dis 20: 903, 1975. [31 Kohn EC, Francis EA, Liotta LA, Schiffman E: Heterogeneity of the motility responses in malignant tumor cells: a biological basis for the diversity and homing of metastatic cells. Int J Cancer 46: 287, 1990.
Fig. 1. Barium enema study demonstrated barium from the colon to the stomach and down to the small bowel, a filling defect over the transverse colon, and no visible dye filling of the ascending colon and cecum.
Letter to the editor
Gastrocolic fistula due to a metastatic marginal ulcer from . carcinoma of the cervix J.-M. Chiang*, J.Y. Wang Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan, China
Received 21 April 1994; revision received I5 May 1994; accepted 3 June 1994
Keywords:
Gastrocolic
fistula; Cervical
cancer; Gastrointestinal
We present a case of squamous cell cancer of the uterine cervix with solitary distant gastrointestinal metastases 4 years after treatment. A 60-year-old Chinese female was admitted to hospital for nausea, anorexia, postprandial vomiting and watery diarrhea lasting 1 month. Five years earlier she had been diagnosed with chronic duodenal ulcer with pyloric obstruction and treated by subtotal gastrectomy and BillrothII reconstruction. Four years earlier she had been diagnosed with stage-IIb squamous cell cancer of the uterine cervix and was treated with irradiation. She tolerated the treatment well and became free of local disease. On admission she was pale and had evidence of weight loss (4-5 kg/month). Gynecologic examination did not reveal any local recurrence. Fiber optic upper gastrointestinal endoscopy demonstrated a marginal ulcer in the gastrojejunostomy. A barium enema study demonstrated barium from
* Corresponding author, Tel.: (03) 3281200, Ext. 2101; Fax: (03) 3284239. 0020.7292/94/$07.00 0 1994 International SSDI 0020-7292(94)02173-V
metastasis
the colon to the stomach and down to the small bowel, a filling defect over the transverse colon and no visible barium filling of the ascending colon and cecum (Fig. 1). The chest posterior-anterior (PA) film and routine laboratory parameters were within normal limits except for the presence of anemia (Hb = 75 g/dl) and elevated carcinoembryonic antigen level (18.9 &ml). At laparotomy, an indurated mass was found in the previous gastrojejunostomy site fused with the transverse colon. It was resected and revision of the gastrojejunostomy was performed. The postoperative course was relatively smooth and the patient was discharged and followed up for 1 year without evidence of recurrence. Pathological examination of the specimen demonstrated a segment of gastrojejunostomy and a segment of colon that had fused together. Microscopic section showed an ulceration at the junction of the stomach and jejunum which had perforated into the colon. A moderately differentiated squamous cell carcinoma was found with extensive infiltration at the site of the gastrojejunostomy and invasion through muscle layer to the serosa. Lym-
Federation of Gynecology and Obstetrics
174
Letters to the editor/W.
J. Gynecol. Obstet. 47 (1994) 173-174
phatic permeation and perineural invasion were also noted. Solitary gastrointestinal metastasis secondary to cervical carcinoma is rare [ 11. Cervical carcinoma spreads primarily by local extension and lymphatic spread [2]. Distant metastases usually indicate an advanced stage and combine with multiple sites of metastasis [3]. We could, however, find no reports in the literature of such solitary metastasis in gastrojejunostomy presenting as enterocolic tistula and gastric outlet obstruction associated with such an apparently healthy cervix. References VI Caramella E, Bruneton JN, Roux P, Aubanel D, Lecomte P: Metastases of the digestive tract. Report of 77 cases and review of the literature. Eur J Radio1 3: 331, 1983. 121Menuck LS, Amberg JR: Metastatic disease involving the stomach. Am J Dig Dis 20: 903, 1975. [31 Kohn EC, Francis EA, Liotta LA, Schiffman E: Heterogeneity of the motility responses in malignant tumor cells: a biological basis for the diversity and homing of metastatic cells. Int J Cancer 46: 287, 1990.
Fig. 1. Barium enema study demonstrated barium from the colon to the stomach and down to the small bowel, a filling defect over the transverse colon, and no visible dye filling of the ascending colon and cecum.