PMC7260398_01
Endoscopy finding. A. Ulcerofungating mass (5*5 cm) in hepatic flexure (colon). B. Large infiltrating ulcerative mass (7*7 cm) in mid-to-high body in the lesser curvature side (stomach). C. Ulcerative mass (2.3*2.5 cm) in blind loop with Roux-en-Y anastomosis (jejunum).
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He had undergone right hemicolectomy for colon cancer nine months ago (Fig. 1A), and his final pathologic examination showed moderately differentiated adenocarcinoma that had invaded into pericolic tissues (T3). At the nine-month postoperative follow-up study, a gastroscopy revealed a large infiltrating ulcerative mass (7*7 cm) on the high body of the stomach (Fig. 1B), but a colonoscopy revealed no specific findings at the previous operation site. At the 14-month postoperative follow-up visit, gastrofibroscopy showed a tumour (size: 2.3*2.5 cm) in the blind jejunal loop of Roux-en-Y anastomosis (Fig. 1C), which was confirmed as adenocarcinoma through an endoscopic biopsy.
Positron emission tomography-computed tomography (PET-CT). A. Colon cancer (SUV; 12.6) without evidence of distant metastasis (cT3N0M0). B. Gastric cancer (SUV; 11.8) in upper body of stomach without evidence of distant metastasis (cT3N1M0). C. Local recurrence (SUV; 9.4) of previous stomach cancer without metastasis.
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A positron emission tomography-computed tomography (PET-CT) scan only showed gastric uptake (maximum standardized uptake value (SUV), gastric cardia-11.8) without evidence of any other metastasis (Fig. 2B). SUV, blind loop-9.4) without evidence of any other metastasis (Fig. 2C).
Histologic examination of biopsy. A: colon, B: stomach, C: jejunum.. Colon cancers including metastatic gastric and jejunal cancers were all relatively moderate differentiated adenocarcinomas, intestinal type (Gastric ca, H&E, x100). Homogenous, high levels (3+) of CDX2 expression (x100) were found in primary colonic and metastatic, as well as gastric and jejunal adenocarcinomas. The immunohistochemical staining for cytokeratin (CK) profile (x100) demonstrated the same immunoreactivities in both primary colonic and metastatic, as well as gastric and jejunal adenocarcinomas: CK 20 (+) & CK 7 (-).
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They all indicated relatively moderately differentiated adenocarcinoma of intestinal type (Fig. 3 Gastric cancer, H&E, x100). Immunohistochemical (IHC) staining showed homogenous high levels (3+) of CDX2 expression (Fig. 3A-C) in the primary colon cancer and gastric and jejunal adenocarcinomas. Further IHC staining for cytokeratin (CK) profiles demonstrated the same immunoreactivity in both the primary colon cancer as well as the gastric and jejunal adenocarcinomas: CK20(+) and CK7(-) (Fig. 3A-C).