"Simultaneous Occurrence of Adenocarcinomas in the Stomach and Biliary " by Faisal M. Nimri, Taher Jamali et al.
 

Simultaneous Occurrence of Adenocarcinomas in the Stomach and Biliary Tree: A Rare Case Report

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Synchronous adenocarcinomas in stomach and biliary tree are extremely rare phenomenon, with very scarce literature. The factors leading to the development of synchronous primary cancers within the gastrointestinal (GI) tract remain poorly understood, but genetic predisposition, environment and molecular alterations may play a role. Case Description/Methods: A 66 year old man with history of hypertension, dyslipidemia, and prostate cancer was evaluated by hepatology clinic for new and persistent elevation of liver enzymes (LFTs) on routine check-up with alanine aminotransferase of 137 IU/L, aspartate aminotransferase of 60 IU/L, and alkaline phosphatase of 415 IU/L, while he had normal total bilirubin of 0.8 mg/dL, and INR 0.99. All LFTs were normal a year ago. He denied any associated symptoms. Further testing including viral hepatitis panel, autoimmune liver diseases, and hemochromatosis testing were negative. Liver US was normal. Magnetic resonance imaging with magnetic resonance cholangiopancreatography revealed a 2cm central lesion with left intrahepatic biliary ductal dilatation and questionable delayed enhancement. Advanced GI performed esophagogastroduodenoscopy which showed an ulcerated and friable tumor on the gastric antrum greater curvature concerning for malignancy and was biopsied. Endoscopic ultrasound to characterize the mass showed invasion into at least the muscularis propria. Endoscopic retrograde cholangiopancreatography revealed a single moderate biliary stricture found in the left main hepatic duct. Exploration with cholangioscopy demonstrated focally abnormal epithelium concerning formalignancy, and was biopsied and brushing performed for fluorescence in situ hybridization (FISH) and cytology. The right hepatic duct was not involved though could be secondarily compressed. Common bile duct and CHD were normal. A biliary sphincterotomy was performed.The stricture was dilated to 4 mm (with persistent waist) then stented with a 7 Fr by 12 cm straight plastic biliary stent. Pathological analysis of both gastric and left main hepatic duct stricture revealed moderately differentiated adenocarcinoma. FISH Bile Duct Malignancy panel showed evidence of trisomy 7 which has only a little evidence to suggest that trisomy 7 meets the criteria for a diagnosis of cholangiocarcinoma. Discussion: This case report highlights a rare occurrence of simultaneous diagnosis of 2 adenocarcinomas, one in the stomach and the other in the biliary tree. It is challenging to determine whether these are 2 primary adenocarcinomas in 2 anatomically separate sites versus one primary lesion while the other is a metastatic lesion of that primary. Such a presentation is extremely rare and proposes challenging clinical diagnostic and therapeutic scenarios. (Figure Presented).

Volume

119

Issue

10

First Page

S1822

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