Gastric cancer and adenomatous colorectal polyp concomitant with pyogenic liver abscess and bacteremia

Abstract

Synchronous gastric cancer and adenomatous colorectal polyp in patients with Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) and bacteremia is a rare presentation. A 58-year-old man with a 6-month history of diabetes mellitus (DM) presented with febrile sensation and dull abdominal pain in the right upper quadrant of the abdomen. Subsequent to laboratory test results and abdominal computed tomography findings, KP-PLA with bacteremia was diagnosed. After intravenous antibiotic administration, his symptoms improved, and upper endoscopy and colonoscopy were performed to evaluate the cause of KP-PLA. Biopsy specimens of the prepyloric anterior wall revealed a moderately differentiated adenocarcinoma. Endoscopic mucosal resection of the colon revealed high-grade dysplasia. Early gastric cancer (EGC) and adenomatous colorectal polyps with high-grade dysplasia concomitant with KP-PLA and bacteremia were diagnosed in our patient who had DM. Intravenous antibiotic treatment for KP-PLA, subtotal gastrectomy for EGC, and colonoscopic mucosal resection for the colon polyp were performed. After 25 days of hospitalization, subtotal gastrectomy with adjacent lymph node dissection was performed. Follow-up ultrasound imaging showed resolution of the abscess 5 weeks post-antibiotic treatment, as well as no tumor metastasis. Upper gastrointestinal endoscopy and colonoscopy should be performed to evaluate gastric cancer in patients with PLA or bacteremia, accompanied with DM or an immunocompromised condition.

Keywords: Adenomatous polyps; Klebsiella pneumoniae; Pyogenic liver abscess; Stomach cancer.

Fig. 1.

Initial abdominal computed tomography shows a low attenuated lesion (arrow) measuring approximately 2.1×1.8 cm in size with an irregular margin in the right liver lobe in the portal phase.

Fig. 2.

(A) Upper gastroscopy shows several nodular lesions (arrow) measuring 2 cm in size with an irregular margin with erosion from the anterior wall to the lesser curvature of the prepyloric antrum. (B) Colonoscopy shows a pedunculated polyp measuring approximately 1.5 cm in size at the sigmoid colon. (C) The prepyloric nodular lesions show moderately differentiated adenocarcinoma (hematoxylin and eosin [H&E] stain, ×100). (D) The resected colon polyp shows tubular adenoma with high-grade dysplasia. Tumor cells have hyperchromatic nuclei, with cribriform pattern (H&E stain, ×100).