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World J Gastroenterol. Feb 14, 2007; 13(6): 960-963
Published online Feb 14, 2007. doi: 10.3748/wjg.v13.i6.960
Published online Feb 14, 2007. doi: 10.3748/wjg.v13.i6.960
Gastric adenocarcinoma inducing portal hypertension: A rare presentation
Pradipta Ghosh, Mario Chojkier, Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego; San Diego, California, United States
Katsumi Miyai, Department of Pathology, University of California, San Diego; San Diego, California, United States
Mario Chojkier, Veterans Affairs Medical Center, Cancer Center, University of California, San Diego, California, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Pradipta Ghosh, Department of Medicine, University of California, San Diego, San Diego, CA 92161, USA 3350 La Jolla Village Dr. (9111-D), San Diego, CA 92161-0002, United States. prghosh@ucsd.edu
Telephone: +1-858-5342766
Received: September 23, 2006
Revised: October 28, 2006
Accepted: December 22, 2006
Published online: February 14, 2007
Revised: October 28, 2006
Accepted: December 22, 2006
Published online: February 14, 2007
Abstract
Advanced gastric cancer usually presents with symptoms due to direct extension into adjacent viscera, distant metastases from lymphatic or hematogenic dissemination and peritoneal seeding. However, portal hypertension as a presentation of metastatic gastric cancer is rare and usually seen in association with other malignancies, e.g. hepatocellular and pancreatic carcinoma. We report a case of signet ring adenocarcinoma of the stomach that presented with esophageal and duodenal varices and bleeding due to portal hypertensive gastropathy. Pagetoid spread of cancer cells likely caused early metastasis and the unusual presentation. We also discussed the pathophysiology of development of portal hypertension in association with malignancies.