Skin metastasis of an oropharyngeal laryngeal squamous cell carcinoma around the percutaneous endoscopic gastrostomy tube (PEG)

Introduction:

Patients with pharyngeal/oesophageal tumors often require a gastrostomy to maintain nutrition. The installation of a PEG tube is the method of choice. A rare complication of this technique is the metastasis of the tumor on the abdominal wall.

Case presentation:

In a 58-year-old patient with a T4N2bM0 oropharyngeal laryngeal squamous cell carcinoma, a tracheostomy was performed at baseline, followed by primary radiochemotherapy. As a result of infiltration of the upper esophagus, the patient developed an esophagotracheal fistula. To secure the nutrition, the installation of a PEG tube was performed. One year later, the patient complained of a painful granulation tissue around the PEG tube. Histological examination revealed a metastatic squamous cell carcinoma. This was primarily resected.

Discussion:

The abdominal wall metastasis of a pharyngeal carcinoma is a rare complication after implantation of a PEG tube. The incidence of the case is reported in the literature at 0.64%. Metastases are treated by primary resection and full-skin reconstruction. Period between the installation of the PEG tube and diagnosis of the metastasis in literature is about 8 months, in our case one year. The survival period after the diagnosis of the metastases is given as 5.9 months. The risk factors of metastasis are large primary tumor, high or moderate degree of malignancy, squamous cell carcinoma and old age of the patients. As an alternative to the PEG tube, an open or laparoscopic gastrostomy can be performed.

Summary:

Abdominal wall metastasis of oropharyngeal carcinoma is a serious complication with poor prognosis. For large tumors, an open gastrostomy should be considered and discussed with the patient.

Publication History

Publication Date:
18 April 2018 (online)