The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Discovery of Gastric Adenocarcinoma 
during PEG Tube Placement in Patient 
with Epiglottic Squamous Cell Carcinoma 
SJ Halloran, M31*, S Stanley, DO1, J Burlen, MD1, M Aziz, MD1, B Hart, MD, PhD, 
MPH1

1Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: sean.halloran@rockets.utoledo.edu

Published: 05 May 2023 

Introduction:  Multiple primary neoplasms constitute up to 2-17% of cancer diagnoses. We report a 
patient who was diagnosed with gastric adenocarcinoma at the time of percutaneous endoscopic 
gastrostomy (PEG) tube placement for dysphagia secondary to squamous cell carcinoma of the anterior 
epiglottis.     

Case Description:  A 77-year old male presented for upper endoscopy with PEG tube placement. Two 
months prior, the patient was diagnosed with p16 negative invasive squamous cell carcinoma of the 
anterior epiglottis. He was referred for PEG tube placement for nutrition supplementation due to 5 
months of progressive dysphagia, malnutrition, and unintentional weight loss. Social history was 
significant for tobacco dependence with 52 pack years and alcohol dependence. At the time of PEG tube 
placement, a 1.5 cm excavated lesion at the gastric incisura was identified. Biopsy was performed to rule 
out malignancy. PEG tube was successfully placed. Biopsy was consistent with diffuse type signet ring 
gastric adenocarcinoma. PET scan 1 month prior to PEG tube placement showed no foci of abnormal 
FDG uptake outside of the primary lesion in the epiglottis. Patient is undergoing treatment for laryngeal 
carcinoma with chemotherapy and radiation. Assessment and treatment for gastric cancer diagnosis will 
be deferred until completion of treatment for laryngeal carcinoma.    

Discussion:  Concurrent laryngeal and gastric cancer is a unique diagnosis not well reported. Literature 
shows that signet ring cell carcinomas has significantly lower 18F-FDG uptake than other forms of 
gastric cancer. These findings highlight the importance of completing a full endoscopic evaluation in all 
patients undergoing endoscopy. 

https://dx.doi.org/10.46570/utjms.vol11-2023-672 

https://dx.doi.org/10.46570/utjms.vol11-2023-672
mailto:sean.halloran@rockets.utoledo.edu