A descriptive analysis of 30 cases with metastatic tumors of gastrointestinal tracts.

Abstract

Backgrounds and Aims: Metastatic tumors of gastrointestinal tract are not rare in autopsies but they are hardly encountered in clinical fields. They will be expected to be diagnosed more frequently with aging and prolonged survival with the advances of anticancer therapeutics. Since metastatic tumors of gastrointestinal tract developed by direct invasion of adjacent lesions, intraperitoneal dissemination, or hematogenous spread would grow from mesenteric sides to mucosal surfaces, they are asymptomatic at earlier stage but when advanced, leads fatal complications such as intestinal perforation, obstruction, and bleeding. This study was performed to describe the pathologic findings, primary sites, metastatic sites and endoscopic features of metastatic gastrointestinal tumors.

Methods: After searching for pathologic specimens which were obtained from surgery or endoscopic biopsy during the year 2001 to 2007 in Hanyang University Hospital in Korea, we retrospectively analysed 30 cases(37 lesions) of metastatic tumors of esophagus, stomach, small intestine, cecum, appendix, colon, and rectum metastasized from anywhere in the body. The primary sites, pathologic types of the primary lesions, and endoscopic findings in cases of cecal and colonic metastasis were reviewed.

Results: The age ranged from 45 to 80 with a mean of 63. The metastatic sites were 2 cases in esophagus, 2 in stomach, 14 in small intestines, 2 in cecum, 10 in colon, and 4 in rectum. The primary sites were 11 lesions from stomach, which was the most common site, 2 from rectum, 2 from liver, 3 from ovary, 2 from uterine cervix, 2 from breast and 2 from hypopharynx. There was 1 case each in duodenum, gall bladder, lung, thyroid, colon, and pancreas. Pathologic findings of the primay lesions were as follows; adenocarcinoma was most commonly encountered as 21 cases, squamous cell carcinoma was 4 cases, signet ring cell carcinoma 3 cases, cholangiocarcinoma 1 case, carcinosarcoma 1 case, and thyroid papillary carcinoma was 1 case respectively. In some cases of cecal and colonic metastasis, the endoscopic findings were three patterns as follows, 1)mucosal edema encircling the involved lumen, 5 cases, 2)submucosal tumor-like lesion, 3 cases, 3)ulcerofungating, the same feature as in cases of primary colonic neoplasia, 2 cases.

Conclusions: The increased recognition of metastatic tumors of gastrointestinal tracts is needed because they are thought to be diagnosed more frequently according to aging and prolonged survival of cancer patients. Knowledge of the biologic features and endoscopic findings of them will make it possible to prevent fatal complications and favor the outcomes of patients with metastatic gastrointestinal tumors.