Abstract
Purpose: SPGN presenting as colon and gastric adenocarcinomas have been reported in medical literature. Presence of SPGN at other locations and histological types are extremely rare. We report SPGNs presenting as simultaneous colon cancer with esophageal cancer and, rectal cancer with linitis plastica, a rare form of gastric cancer. Case Report 1: 44 year old Hispanic male with no past medical history was referred for evaluation of epigastric pain, bloating associated with hematochezia for two weeks. Laboratory studies including CEA level were within normal limit. Upper gastrointestinal endoscopy (UGE) revealed large friable exophytic mass in the mid esophagus extending from 30 cm to 38 cm from incisor. Colonoscopy revealed presence of a large broad based polypoid mass lesion occupying half of the circumference of the sigmoid colon (SC) and a 2cm pedunculated polyp in SC. The biopsies revealed invasive moderately differentiated squamous cell carcinoma of esophagus, moderately differentiated adenocarcinoma of SC and tubular adenoma with high grade dysplasia. Endoscopic ultrasound of esophageal mass was consistent with T3 N1 lesion (stage III A). Case Report 2: 81 year old Italian male with hypertension was admitted to the hospital for evaluation of poor oral intake because of dysphagia and rectal bleeding. Laboratory studies were within normal limit. UGE showed diffusely thickened and hypertrophic gastric folds involving the entire stomach up to 5 cm proximal to pylorus. The stomach could not be insufflated with air due to diffuse involvement consistent with endoscopic appearance of linitus plastica. Gastroesophageal junction was also appeared to be involved in the disease process. Colonoscopy showed presence of two distinct polypoid circumferential mass lesions in rectum extending from 10-18 cm and 20-25 cm from anal verge respectively. Biopsies were suggestive of infiltrating poorly differentiated adenocarcinoma of stomach, invasive moderately differentiated adenocarcinoma of rectum and tubulovillous adenoma with high grade dysplasia. Pt underwent exploratory laparotomy and gastric tumor was found to be extending into distal esophagus and it was unresectable. Discussion: Simultaneous detection of esophageal squamous cell carcinoma and colonic adenocarcinoma has not been reported earlier. Presence of linitis plastica with rectal adenocarinoma is extremely rare. Conclusion: The cases suggest the need of complete evaluation of gastrointestinal tract in a patient with gastrointestinal cancer.
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