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• W2912342776 abstract "Gastric cancer (GC) is the 15th most common cancer in the US and effects more men than women. Common age at diagnosis is 65-74 years old with a median of 69. It has a 5% 5 year survival when diagnosed with mets. An 87yo Hispanic F presented with constipation and abdominal pain for two months. Pain was generalized, dull and constant; not alleviated with medication. She had lost ten pounds over three weeks and was nauseas, but denied vomiting. No changes in stool, hematochezia, melena or hematemesis. No family history of GI malignancy. She denied tobacco, alcohol and drug use. Vital signs were normal. PE showed generalized abdominal tenderness to palpation; no rebound, guarding or palpable masses. CT of the abdomen showed a 2.4x1.9cm pancreatic mass with multiple lymph nodes around it, portal vein compression, and a lung base nodule (confirmed on Chest CT). Labs were notable for CA19-9 of 61.25U/mL, AST 639U/L, ALT 369U/L, ALP 463 U/L, T Bili 1.32mg/dL and D Bili 1mg/dL. She was admitted and an EGD showed a large malignant appearing, non-bleeding and deep ulcer with heaped edges on the proximal portion of the greater curvature of the antrum. EUS showed a 28.3x31.4mm complex solid cystic mass in the body of the pancreas. Pathology reported invasive moderately differentiated adenocarcinoma (primary vs. metastatic); negative for H. pylori. Further immunohistochemical testing showed both specimens were negative for PODXL-1 and CA19-9, supporting primary gastric adenocarcinoma with pancreatic mets. MRCP showed 1cm area of narrowing in the proximal common hepatic duct near the porta hepatis and multiple pancreatic cystic masses. Her symptoms resolved and she did not want therapy; she was made DNR/DNI. She was discharged but was readmitted 3 days later with the same symptoms, now with vomiting and conjunctival icterus. Labs were notable for AST 347, ALT 356, ALP 1248, T Bili 10.96 and D Bili 6.5. An ERCP showed a cutoff of 3cm in the proximal common hepatic duct 1cm below the confluence. It was successfully stented with a 6cmx10mm metallic uncovered stent. Her symptoms resolved and she was discharged to home hospice, in accordance with her wishes. While she had typical symptoms for both pancreatic and GC, this case highlights the importance of doing a full workup. The GC was not seen on CT scan and would have been missed had the EGD/EUS not been done. Only a handful of cases of GC with metastasis to the pancreas have been reported in the literature.Figure: EGD showing gastric mass, pre-biopsy.Figure: EGD showing gastric mass, post-biopsy.Figure: ERCP showing stented hepatic duct." @default.
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• W2912342776 date "2017-10-01" @default.
• W2912342776 modified "2023-09-27" @default.
• W2912342776 title "A Pancreatic Mass: Atypical Presentation of Gastric Cancer" @default.
• W2912342776 doi "https://doi.org/10.14309/00000434-201710001-02640" @default.
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