S3046 Gastrocolic Fistula Secondary to Gastric Squamous Cell Carcinoma

Abstract

INTRODUCTION: This is a case of a 77-year-old African American female developing a gastrocolic fistula (GCF) secondary to gastric squamous cell carcinoma (GSCC); both digestive diseases are very rare. Complaints were inconsistent with GCF as she denied diarrhea and admitted to constipation, weight loss, and vomiting. This case highlights the variable nature of fistulizing lesions and contributes to the limited literature on the presentation of GSCC. Final diagnosis was reached with an enema study and biopsy results. CASE DESCRIPTION/METHODS: This patient presented with intractable nausea and vomiting, a weight loss of 28 pounds and worsening constipation. She denied worsening abdominal pain, fever, chills, and diarrhea. Upper endoscopy revealed a large gastric mass with severe gastric stasis containing feculent material, suggesting a GCF. An enema study demonstrated a fistulous communication of the proximal descending colon and stomach. Exhaustive staining identified poorly differentiated SCC. There was no evidence of primary esophageal SCC on two separate endoscopies. Complete work up for SCC outside of the stomach was negative. Due to age, co-morbidities, and malnutrition, the patient was deemed a poor surgical candidate and was discharged home on hospice. DISCUSSION: This is the first case in medical literature showing a GSCC fistulizing with the colon. Gastric carcinoma is relatively rare in the United States with GSCC comprising only 0.2–2%1 of all gastric cancers. GCF are also rare with an incidence of 0.3–0.4%2. The majority of GCF originate from malignancies in the colon3. This case is presented to alert providers of the possible correlation of these two rare diseases. Early diagnosis of one of these two diseases should lead future providers to consider the other and explore a possible relation between them.Figure 1.: Gastrocolic fistulas seen on Barium enema. Patient complained of reflux-like symptoms while undergoing barium enema procedure.Figure 2.: Large mass with 600cc of feculent gastric fluid.Figure 3.: Hematoxylin and eosin stain of squamous cell carcinoma with accompanying p40 and CK5. Exhaustive staining revealed neoplastic changes consistent with SCC. Image demonstrates the diffuse infiltration of cancer cells into the glandular tissue of the gastric body. A second biopsy and repeat stains were required to identify the lesion and make the diagnosis. Additional staining and imaging confirmed the absence of satellite cancer.