P1902 - Simultaneous Occurrence of Adenocarcinomas in the Stomach and Biliary Tree: A Rare Case Report

Faisal Nimri, MD¹, Taher Jamali, MD¹, Rund Nimri, MD², Tariq Hammad, MD¹, Tobias Zuchelli, MD¹, Sumit Singla, MD^1
1Henry Ford Hospital, Detroit, MI; ²Jordan University of Science and Technology, Irbid, Irbid, Jordan

Introduction: Synchronous adenocarcinomas in stomach and biliary tree are extremely rare phenomenon, with very scarce literature. The factors leading to the development of synchronous primary cancers within the GI tract remain poorly understood, but genetic predisposition, environment and molecular alterations may play a role.






Case Description/Methods: A 66 year old man with history of hypertension, dyslipidemia, and prostate cancer was evaluated by hepatology clinic for new and persistent elevation of liver enzymes (LFTs) on routine check-up with ALT of 137 IU/L, AST of 60 IU/L, and ALP of 415 IU/L, while he had normal total bilirubin of 0.8 mg/dL, and INR 0.99. All LFTs were normal a year ago. He denied any associated symptoms. Further testing including viral hepatitis panel, autoimmune liver diseases, and hemochromatosis testing were negative. Liver US was normal. MRI with MRCP revealed a 2cm central lesion with left intrahepatic biliary ductal dilatation and questionable delayed enhancement. Advanced GI performed EGD which showed an ulcerated and friable tumor on the gastric antrum greater curvature concerning for malignancy and was biopsied. EUS to characterize the mass showed invasion into at least the muscularis propria. ERCP revealed a single moderate biliary stricture found in the left main hepatic duct. Exploration with cholangioscopy demonstrated focally abnormal epithelium concerning for malignancy, and was biopsied and brushing performed for FISH and cytology. The right hepatic duct was not involved though could be secondarily compressed. CBD and CHD were normal. A biliary sphincterotomy was performed. The stricture was dilated to 4 mm (with persistent waist) then stented with a 7 Fr by 12 cm straight plastic biliary stent. Pathological analysis of both gastric and left main hepatic duct stricture revealed moderately differentiated adenocarcinoma. FISH Bile Duct Malignancy panel showed evidence of trisomy 7 which has only a little evidence to suggest that trisomy 7 meets the criteria for a diagnosis of cholangiocarcinoma.

Discussion: This case report highlights a rare occurrence of simultaneous diagnosis of two adenocarcinomas, one in the stomach and the other in the biliary tree. It is challenging to determine whether these are two primary adenocarcinomas in two anatomically separate sites versus one primary lesion while the other is a metastatic lesion of that primary. Such a presentation is extremely rare and proposes challenging clinical diagnostic and therapeutic scenarios.



Disclosures:


Faisal Nimri, MD¹, Taher Jamali, MD¹, Rund Nimri, MD², Tariq Hammad, MD¹, Tobias Zuchelli, MD¹, Sumit Singla, MD¹. P1902 - Simultaneous Occurrence of Adenocarcinomas in the Stomach and Biliary Tree: A Rare Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.