Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2015 Jan 26:9:13.
doi: 10.1186/1752-1947-9-13.

A multidisciplinary approach to an unusual medical case of locally advanced gastric cancer: a case report

Nicola Carlomagno  1 , Fabrizio Schonauer, Vincenzo Tammaro, Annalena Di Martino, Carmen Criscitiello, Michele L Santangelo
Affiliations
Case Reports

A multidisciplinary approach to an unusual medical case of locally advanced gastric cancer: a case report

Nicola Carlomagno et al. J Med Case Rep. .

Abstract

Introduction: Complete abdominal wall infiltration with neoplastic gastrocutaneous fistula is an unexpected and out of the ordinary presentation of locally advanced gastric cancer. It is very rare to encounter case reports presenting diffuse abdominal wall invasion, but a complete parietal destruction is an exceptional event.

Case presentation: Here we describe the case of an 81-year-old Caucasian woman presenting a carcinoma perforating her anterior gastric wall and infiltrating all layers of her abdominal wall. The gastric tumor infiltrated her transverse mesocolon, the rectus abdominis muscles bilaterally and overran them anteriorly, causing a large parietal deficit and a complete external fistula. Treatment consisted of a complex surgical procedure requiring general and reconstructive surgery cooperation in order to perform an en bloc gastric resection including colon and abdominal wall, followed by a parietal reconstruction through positioning of prosthesis and reverse abdominoplasty.

Conclusions: Clinical presentation, histology and therapeutic options are discussed. The importance of a multidisciplinary approach when encountering extremely rare clinical presentations is emphasized.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Computed tomography scan: huge mass arising from the gastric antrum, infiltrating and perforating the abdominal wall.
Figure 2
Figure 2
Preoperative planning: horizontal skin ellipse with 2cm margin of healthy perilesional skin tissue.
Figure 3
Figure 3
Specimen of en bloc resection of stomach, transverse colon, rectus abdominis and soft tissue of the abdominal wall.
Figure 4
Figure 4
Residual parietal defect after resection.
Figure 5
Figure 5
Skin defect closure with reverse abdominoplasty flap.
Figure 6
Figure 6
Hematoxylin and eosin infiltration of gastric wall (a) by cells organized in a solid pattern with foci of necrosis (b) by neoplastic cells with pleomorphic nuclei and high nucleocytoplasmic ratio, with a trabecular and organoid pattern; (c) by tumor cells with vesicular nuclei, amphophilic cytoplasm, in a solid pattern of growth with central necrosis. (d) At immunohistochemistry neoplastic cells with high CD56 membrane positivity suspicious for neuroendocrine differentiation.
See this image and copyright information in PMC

References

    1. Hartgrink HH, Jansen EP, van Grieken NC, van de Velde CJ. Gastric cancer. Lancet. 2009;374:477–490. doi: 10.1016/S0140-6736(09)60617-6. - DOI - PMC - PubMed
    1. Fernández-Fernández FJ, Sesma P. Gastric cancer. Lancet. 2009;374:1594–1595. doi: 10.1016/S0140-6736(09)61947-4. - DOI - PubMed
    1. Santangelo M, Vescio G, Sommella L, Battaglia M, Valente A, Sammarco G, Bossa F, Triggiani E. Extended total gastrectomy: indications in the 3rd millennium. Minerva Chir. 2001;56(1):1–6. - PubMed
    1. Tammaro V, Carlomagno N, Lombari P, Tedesco G, Renda A. Prognostic value of splenectomy and lymph-node dissection during gastric cancer resection. Chir Ital. 2006;58(2):163–170. - PubMed
    1. Feczko PJ, Collins DD, Mezwa DG. Metastatic disease involving the gastrointestinal tract. Radiol Clin North Am. 1993;31:1359–1373. - PubMed

Publication types