Malignant Seeding of Percutaneous Endoscopic Gastrostomy Tract in Patient With Head and Neck Cancer

ABSTRACT Malignant seeding of the percutaneous endoscopic gastrostomy (PEG) stoma is a rare and unusual complication of PEG performed in patients with head and neck cancer. Direct seeding of PEG stoma is believed to be the culprit. We present one such case of metastasis that lends support to an alternate hypothesis of vascular spread. First responders in such cases are usually not gastroenterologists and may include dieticians, primary care physicians, and radiologists. As such, we also provide pictures that would help the health care providers recognize this rare entity and manage appropriately and promptly. Percutaneous endoscopic gastrostomy (PEG) is routinely performed as a means of nutritional support for patients undergoing chemoradiation and surgery for head and neck cancers. Recently, there have been concerns about a possible malignant seeding of the PEG track. A recent review documented a total of 44 cases in the literature. 1 It is widely believed that the seeding occurs as a result of direct invasion. We present a case of metastatic seeding of the PEG track and provide evidence for another plausible mechanism, ie, vascular dissemination.