Percutaneous Endoscopic Gastrostomy Site Metastasis in a Patient with Esophageal Cancer

Figure 1 An abdominal wall tumor with a diameter of 3 cm (Figure [1]) had formed at the site of a percutaneous endoscopic gastrostomy (PEG). The PEG had been inserted 10 months earlier using the pull-through technique in a 63-year-old patient with locally advanced squamous-cell carcinoma of the upper esophagus. The primary tumor had been treated with palliative chemoradiotherapy, which resulted in complete remission.

Figure 2 The PEG-associated tumor was histologically identical to the original malignancy (Figure [2], hematoxylin/eosin stain) and was treated by resection of the affected abdominal wall and subtotal gastrectomy. This case illustrates the fact that malignant cells from a stenotic esophageal cancer can be sheared off when a PEG plate is being pulled through and that they remain capable of forming metastases even after chemoradiotherapy.