Percutaneous endoscopic gastrostomy (PEG) is frequently performed in patients suffering
from head and neck carcinoma to provide adequate nutrition after radiation therapy.
Metastases of the original tumor at the cutaneous exit of the gastrostomy may occur,
but have rarely been described up to now [1].
A 75-year-old woman who suffered from a T4N0M0 hypopharyngeal carcinoma underwent
gastroscopy for PEG placement after primary diagnosis was made. A stenotic polypoid
tumor was seen in the pharynx, which was soft. Passage with the gastroscope was easily
performed. A 12 Charr. PEG was placed using the “pull” technique. Subsequent to PEG
implantation the patient received radiation therapy. At 15 weeks later, she developed
an elevated, painless granulomatous lesion at the cutaneous exit of the PEG (Figure
[1]). There were no clinical signs of inflammation. With histological examination, a
metastasis of a squamous cell carcinoma was found, which derived from the hypopharyngeal
carcinoma (Figure [2]).
Figure 1 Granulomatous lesion at the exit site of the gastrostomy tube, 4 months after percutaneous
endoscopic gastrostomy (PEG) placement.
Figure 2 Histological specimen from the percutaneous endoscopic gastrostomy (PEG) exit site,
demonstrating a cutaneous metastasis of a squamous cell carcinoma.
In the present case, as in 19 previously reported cases of implantation metastases
at PEG exit sites [1], PEG was performed using the “pull” technique. No technical problems occurred during
PEG insertion. The retention plate passed the tumor easily, without consecutive tumor
bleeding or destruction of the tumor.
As seeding of tumor cells in the abdominal wall appears likely to be caused by transfer
of the inner retention plate, it should be discussed whether placement of the gastrostomy
tube using the “push” method [2] should be proposed, to minimize direct contact with oropharyngeal tumors. In our
own experience, a modification of the “push” technique, performing PEG with gastropexy
in the absence of a retention plate [3], could be a practicable alternative in cases of polypoid head and neck tumors.
