Gastric Adenocarcinoma Presenting with Gastric Outlet Obstruction in a Child

Abstract

Gastric carcinoma is extremely rare in children representing only 0.05% of all gastrointestinal malignancies. Here, we report the first pediatric case of gastric cancer presenting with gastric outlet obstruction. Upper endoscopy revealed a markedly thickened antral mucosa occluding the pylorus and a clean base ulcer 1.5 cm × 2 cm at the lesser curvature of the stomach. The narrowed antrum and pylorus underwent balloon dilation, and biopsy from the antrum showed evidence of Helicobacter pylori gastritis. The biopsy taken from the edge of the gastric ulcer demonstrated signet-ring-cell type infiltrate consistent with gastric adenocarcinoma. At laparotomy, there were metastases to the liver, head of pancreas, and mesenteric lymph nodes. Therefore, the gastric carcinoma was deemed unresectable. The patient died few months after initiation of chemotherapy due to advanced malignancy. In conclusion, this case report underscores the possibility of gastric adenocarcinoma occurring in children and presenting with gastric outlet obstruction.

Ménétrier’s disease associated with gastric adenocarcinoma in a child – imaging aspect

“…Gastric adenocarcinoma (GAC) is extremely rare in children, accounting for about 0.5% of all malignancies of the gastrointestinal tract. 13,14 It usually affects patients between 50 and 70 years, and is uncommon before the age of 40. The etiology of GAC is multifactorial, and risk factors include alcohol consumption, smoking, high-sodium diet, few vegetables, foods with nitrous components, and infections such as Epstein-Barr and H. pylori.…”

“…GAC appears in children sporadically as a consequence of inherited syndromes or after treatment of gastric lymphomas. 13,14 Differential diagnoses for pediatric gastric tumors include stromal tumors, hemangioma, lymphoma, squamous cell carcinoma, carcinoid tumors, fibroids, polyps from hereditary syndromes, leiomyosarcoma, and lipoma. 13,14 Symptoms vary according to the site of involvement and the extent of the tumor.…”

“…13,14 Differential diagnoses for pediatric gastric tumors include stromal tumors, hemangioma, lymphoma, squamous cell carcinoma, carcinoid tumors, fibroids, polyps from hereditary syndromes, leiomyosarcoma, and lipoma. 13,14 Symptoms vary according to the site of involvement and the extent of the tumor. Tumors located in the cardia lead to dysphagic symptoms, while tumors located distal to the cardia gastric produce nonspecific symptoms such as abdominal pain, loss of appetite, weight loss, vomiting, anorexia, fatigue, bloating, hematemesis, and melena.…”

“…Tumors located in the cardia lead to dysphagic symptoms, while tumors located distal to the cardia gastric produce nonspecific symptoms such as abdominal pain, loss of appetite, weight loss, vomiting, anorexia, fatigue, bloating, hematemesis, and melena. [13][14][15] Barium-contrast radiography can be used for initial investigation as an alternative in locations without access to more complex tests. The main findings are polyps, ulcers, discontinuation and thickening of the folds, areas of barium filling defect, loss of gastric distension, and stenoses.…”

“…As a result, gastric adenocarcinomas in pediatric patients have more advanced stage at diagnosis, presenting worse prognosis compared to adults. 13,14 Treatment of GAC in children is usually based on methods used in adults, due to the rarity of this disease in pediatric populations, and therefore there is no standard treatment model. 13,15 references…”