Abstract: TH-PO594
A Case of Hereditary Diffuse Gastric Cancer in a Renal Transplant Patient
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Raghavan, Divya, University of Utah, Salt Lake City, Utah, United States
- Abraham, Josephine, University of Utah, Salt Lake City, Utah, United States
- Swanson, Eric A., University of Utah, Salt Lake City, Utah, United States
- Revelo Penafiel, Monica Patricia, University of Utah, Salt Lake City, Utah, United States
- Ahmed, Faris A., University of Utah, Salt Lake City, Utah, United States
- Hall, Isaac E., University of Utah, Salt Lake City, Utah, United States
- Shihab, Fuad S., University of Utah Health Science Center, Salt Lake City, Utah, United States
Group or Team Name
- Fellow
Introduction
Hereditary diffuse gastric cancer is a highly invasive malignancy which is usually advanced at the time of presentation and associated with a poor prognosis. We report a case diagnosed less than one year after kidney transplantation.
Case Description
A 33-year-old woman with end stage renal disease due to renal agenesis post kidney transplant 8 months ago was admitted with a 5-month history of post-prandial abdominal pain and a 20-pound weight loss. An abdominal CT scan and ultrasound prior to admission were unrevealing. An endoscopy 2 months ago showed gastritis, at which time she started pantoprazole and sucralfate, with no improvement. She was also on tacrolimus, mycophenolate sodium and prednisone. Her family history was significant for stomach cancer in her father who died at age 33 as a result. She had normal vital signs and exam except for a low blood pressure of 99/64. An upper endoscopy showed a localized area of gastritis in the posterior body of stomach which was biopsied. CT scan of the abdomen and pelvis showed mild ascites and a small bowel obstruction. Posterior wall biopsy result came back showing diffuse type adenocarcinoma with signet ring cells. Diagnostic paracentesis showed malignant cells. Genetic testing identified a mutation in CDH1. Patient’s functional status was too poor for chemotherapy and she passed away 2 months from diagnosis.
Discussion
Hereditary diffuse gastric cancer is associated with mutations in a tumor suppressor gene (CDH1) which encodes E-cadherin. Affected individuals develop gastric cancer at a young age. Diffuse gastric cancer in first or second degree relatives under the age of 40 is an indication for genetic testing. Prophylactic gastrectomy is recommended between the age of 20 and 30 in mutation carriers because of the extremely high risk of cancer.
Pathology result showing signet cell adenocarcinoma