Stomal metastases complicating percutaneous endoscopic gastrostomy: CT findings and the argument for radiologic tube placement.
OBJECTIVE
This article describes the CT appearance of metastatic implantation at the percutaneous endoscopic gastrostomy (PEG) tract in patients with malignancy of the upper aerodigestive tract. Cumulative data from previous case reports are also considered for insight into causes of metastasis and the implications for gastrostomy placement in these patients.


CONCLUSIONS
CT showed lobulated soft tissue involving the entire abdominal wall PEG tract in all proven cases. CT is an effective method for evaluation because the tumor burden lies predominately in the abdominal wall and not at the entry or exit site. The stomal implant is often the only site of metastatic disease at presentation. In general, CT findings of mildly increased soft tissue along the PEG tract are nonspecific, but a lobulated mass is highly suspicious for tumor implantation, especially if the one-sided thickness exceeds 1 cm. The preponderance of evidence from the existing literature points to direct tumor implantation during endoscopic placement as the likely cause (rather than hematogenous spread). This conclusion would support the alternative of radiologic tube placement in these patients.
Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889-5600, USA.
Perry J
PJ
Pickhardt
Charles A
CA
Rohrmann
Mark J
MJ
Cossentino
D000009:Abdominal Muscles / Q000000981:diagnostic imaging; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary*; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D054047:Surgical Stomas / Q000009:adverse effects* / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014062:Tongue Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D014067:Tonsillar Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*