Ewing's Sarcoma Metastasis to the Gastric Wall in a 72-Year-Old Patient

Laura Borodyansky Dodis, MD; Michael William Bennett, MD, MB BCh BAO, PhD, MRCPI; David L. Carr-Locke, MD, FRCP Series Editor: David L. Carr-Locke, MD, FRCP

Disclosures

July 10, 2006

Introduction and Case Report

Introduction

Ewing's sarcoma is a neuroectodermal tumor of the bone that may metastasize to other bones and the lungs, and which very rarely spreads to other organs. A review of the literature reveals that a paucity of cancers metastasize to the stomach. Published case reports of those cancers that are found to metastasize to the stomach include malignant melanoma and breast cancer. We report the first case of Ewing's sarcoma metastasis to the gastric wall.

Case Report

A 72-year-old woman with a medical history of Ewing's sarcoma diagnosed 6 years previously presented to her oncologist with complaints of worsening fatigue; left upper quadrant abdominal pain; and black, tarry stools for more than 2 weeks. The Ewing's sarcoma originally involved her left ileum and left femur. She underwent total hip and total knee replacements, local radiation therapy, adjuvant chemotherapy (with cyclophosphamide, adriamycin, and vincristine), and was subsequently treated with a number of targeted chemotherapeutic agents (CP-868596, PPI-2458, and ZD-1839). Her metastatic disease remained reasonably well controlled with local resections, radiation therapy, and chemotherapy. The oncologist noted a 10-point drop in hematocrit -- a decrease of 22% from a baseline in the low 30% range; the patient was sent for urgent outpatient gastrointestinal evaluation. Her medications included lansoprazole and recombinant human erythropoietin; she was not taking nonsteroidal anti-inflammatory drugs, aspirin, warfarin, or clopidogrel.

On evaluation the patient appeared comfortable. She had a blood pressure of 142/56 mm Hg and a heart rate of 100 beats per minute. Physical examination was remarkable solely for external hemorrhoids and melena. An esophagogastroduodenoscopy (EGD) revealed a single, smooth ulcerated bleeding nodule (Figure 1) measuring approximately 1 cm in diameter on the anterior wall of the greater curvature of the stomach. Bleeding was controlled by placement of 3 hemostatic clips along with injection of 1:10,000 epinephrine solution around the bleeding site (Figure 2, Video 1).

Figure 1.

First endoscopic view of gastric nodule.

Figure 2.

Endoscopic view of gastric nodule after placement of 3 hemostatic clips.

 

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Video 1. First endoscopy showing the bleeding gastric nodule and the placement of 3 hemostatic clips.

 


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