Age 52, male
Diagnosis : Rectal Carcinoma, Gastric Carcinoma, Metastases
In February 2004 carcinoma of the lower rectum was found, for which the patient underwent surgical “anterior resection of the rectum with defunctionalized protective colostomy. Marginal prostate radicality.” The discharge diagnosis favored: “Well differentiated adenocarcinoma. Peri-lymph and lymph node metastases in 2 pararectal lymph nodes, microembolic metastasis in 1 inferior mesenteric lymph node.” The patient therefore underwent chemotherapy with Xeloda tablets and radiation therapy as follow-up for surgical treatment. After this, the colostomy was removed with full recovery of functions.
At the end of 2008, in the context of follow-up tests to evaluate digestive problems, high levels of the following tumor markers were found:
CA 19.9 144.86 (< 37)
CA 72.4 86.9 (0 – 4)
Further tests worth mentioning:
- Rx of the Chest (06/2007): Lung growths found at the apex on the right side. Highly dense micro-nodule in the anterior lower right lung field.
- Colonoscopy (06/2008): normal.
- Ultrasound of the upper abdomen (24/10/2008): normal.
- Full-body PET Scan (11/2008): presence of lesions with elevated carbohydrate metabolism on the sub-diaphragmatic lymph node level in the following sites: several lymph nodes at the hepatic hilum, at the interaortocaval site and at the left para-aortic site.
While the tests were being performed, at the end of November 2008, emergency hospitalization at Santa Chiara Hospital in Pisa, where the patient was operated for a perforated pyloric ulcer penetrating the pancreas with pyloric stenosis. This involved gastric resection surgery, Roux gastroenteroanastomosis on the defunctionalized segment, lateral duodenostomy on T-tube, minimal jejunostomy (laparoscopic approach).
The following histological examination report (12/2008) favored: “gastric adenocarcinoma of the G3 diffuse type with “signet ring” cells, infiltrating the entire thickness of the gastric wall. Resection margins unaffected by neoplastic infiltration. Severe collateral dysplasia of the gastric mucosa. Seven lymph nodes with adenocarcinoma metastasis out of a total of 10 examined. pT3N2G3.
Attached is the report for the chest and abdomen CT scans dated 01/2009, which for the most part gave negative findings.
Further hospitalization in Feb 2009 for partial enterostenosis in patient operated for perforated gastric carcinoma. During hospitalization, the chemistry screen results were normal, but gastroesophageal transit brought to light a partial stenosis of the anastomotic jejunal segment. Sedated gastroduodenoscopy was therefore performed, with examination up to about 60 cm beyond the gastro-jejunal anastomosis, with completely negative results. The patient kept the nasogastric tube for 2 days, which did not show any significant stagnation, kept the duodenal drainage open, and was kept on parenteral nutrition. At the time of discharge, the patient was able to consume a semi-liquid diet, but it remains highly doubtful that the symptoms are completely resolved. In light of the recent anamnesis, it is not possible to rule out that the etiopathogenesis can be attributed, in addition to torsions or possible post-operative adhesions, also to the return of the proliferative disease. Indications were given at discharge to proceed with laparotomic surgery in the event that problems continued at home for >48 hours with no possibility for nutrition. The surgery was performed on 02/2009. On March 2009, the patient was still hospitalized at Casa di Cura San Rossore.
This is an addition to the medical information above based on some notes we received from the patient:
On 02/2009, the patient was hospitalized at San Rossore Clinic in Pisa as a result of intestinal occlusion and emesis.
His history is remarkable for previous gastric resection with gastroenteroanastomosis on Roux loop due to hetoroplasia and even previously for low anterior resection of the rectum again due to heteroplasia.
During the last hospital stay, entero-enteric bypass surgery was performed following
peritoneal carcinosis being discovered during the surgical procedure.
Histology of two peritoneal nodules revealed: fibrous tissue infiltrated by neoplastic
epithelial cells of small dimensions and poor cohesion.
In summary, the report states: “Peritoneal metastases of undifferentiated carcinoma. (these traits are compatible with carcinoma of gastric origin).