Disease recurrence following cetuximab completion and declining a gastrectomy: what next to manage Ménétriers disease?

Abstract

Ménétriers disease is a rare mucosal hyperproliferative disorder of the stomach, however, the evidence for long-term care remains limited, especially if a gastrectomy is declined. We present a case of 25-year-old Caucasian woman with a history of end-stage renal failure (ESRF) who experienced worsening symptoms of abdominal pain, haematemesis and abdominal swelling, with her serum albumin dropping to 20 g/L and haemoglobin to 4.9 g/dL. Endoscopy showed markedly hyperplastic gastric folds consistent with Ménétriers disease, confirmed histologically by gland dilation and gastric pit expansion. Intravenous cetuximab was prescribed for 12 months, with clinical, biochemical and endoscopic improvement. However, 5 weeks post cetuximab completion, there was relapse to 50% gastric coverage with Ménétriers. A discussion around gastrectomy was rejected by the patient. This is the first report of relapsing Ménétriers disease in a female patient with ESRF; we suggest that long-term cetuximab should be considered if a gastrectomy is declined.

Figure 1

Endoscopy showing Ménétriers disease with (A) hypertrophied gastric folds with polypoid features in the upper and lower stomach, (B) remission of Ménétriers disease with the lesser curvature the only site of hypertrophied folds, and (C) relapse of Ménétriers disease 5 weeks after cetuximab completion.

Figure 2

Histological examination of this full thickness gastric body biopsy showing prominent expansion of the gastric pits, which have a corkscrew appearance in places. There is also cystic dilation of glands in the basal portion of the mucosa.