Chelimilla Haritha, Ihimoyan Ariyo, Niazi Masooma, Dev Anil
Division of Gastroenterology, Bronx-Lebanon Hospital Center, Bronx, N.Y., USA.
Case Rep Gastroenterol. 2012 May;6(2):496-501. doi: 10.1159/000341524. Epub 2012 Jul 24.
Gastric ulcer secondary to direct invasion from pancreatic adenocarcinoma is rare. Metastases to the stomach have been commonly reported with melanoma and with primary tumors of the breast, lung, ovary, liver, colon and testis. We report a patient who presented with epigastric pain and in whom subsequently upper endoscopy showed a malignant gastric ulcer secondary to direct invasion from pancreatic adenocarcinoma of the body. An 81-year-old female presented to our hospital with epigastric pain and subsequently underwent endoscopy with endoscopic ultrasound for evaluation of a pancreatic body mass. She had a large gastric ulcer in the fundus which was in direct continuity with the pancreatic mass. Pathology from biopsy of the ulcer revealed invasive well-to-moderately-differentiated adenocarcinoma, and immunohistochemical stains were strongly positive for CA19-9, CK7, CK19 and carcinoembryonic antigen. These findings were consistent with a histopathological diagnosis of metastatic carcinoma of the pancreas. Patients with gastrointestinal metastases usually have advanced malignancy with poor prognosis. Endoscopic evaluation with adequate biopsies should be performed for symptomatic patients.
胰腺腺癌直接侵犯继发的胃溃疡很少见。胃转移常见于黑色素瘤以及乳腺、肺、卵巢、肝、结肠和睾丸的原发性肿瘤。我们报告一名出现上腹部疼痛的患者，随后上消化道内镜检查显示为胃体部胰腺腺癌直接侵犯继发的恶性胃溃疡。一名81岁女性因上腹部疼痛就诊于我院，随后接受了内镜检查及内镜超声检查以评估胰腺体部肿块。她的胃底部有一个大的胃溃疡，与胰腺肿块直接相连。溃疡活检病理显示为浸润性高分化至中分化腺癌，免疫组化染色CA19-9、CK7、CK19和癌胚抗原均呈强阳性。这些发现与胰腺转移癌的组织病理学诊断一致。胃肠道转移患者通常患有晚期恶性肿瘤，预后较差。对于有症状的患者应进行充分活检的内镜评估。
