Percutaneous endoscopic gastrostomy associated gastric metastasis.

An interesting case of gastric metastasis of head and neck cancer after percutaneous endoscopic gastrostomy (PEG) placement is presented. Gastric metastases may appear in 3 morphologic varieties endoscopically. They may be multiple nodules of varying size, submucosal tumor masses with tip ulceration, or nonulcerated masses. Histologically, they may be seen as microscopic infiltration, a gross nodule, gross ulceration, or a gross hypertrophied wall. A case of PEG associated gastric metastasis has been reported almost every year since 1989. Even then, PEG placement by pull method continues to be a common procedure for patients diagnosed with head and neck cancer. The mechanism of gastric metastasis in patients with PEG is unclear. Seeding as well as hematogenous and lymphatic spread to traumatized tissue may be the cause.