Gastric varices formation due to pancreatic tumor: a case of successful resection of cystadenocarcinoma

Gastric adenocarcinoma inducing portal hypertension: A rare presentation

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.

Pancreatic cancer presenting as bleeding gastric varices

Given the extremely poor prognosis of pancreatic adenocarcinoma, early diagnosis is crucial; however, clinical signs and symptoms of the disease are neither sensitive nor specific. In the two cases described, previously undiagnosed pancreatic cancers initially presented with upper gastrointestinal tract hemorrhage. Endoscopic surveys to identify the origin of the bleeding revealed gastric varices secondarily attributed to splenic vein thrombosis. Upon further investigation, the splenic vein occlusions were found to be caused by pancreatic tumors. A review of the incidence, pathogenesis, diagnostic modalities, and implications of splenic vein occlusion is included.