Gastric cancer with Situs Inversus
A. Hassouni*, H. Haddad, N. Tawfiq, Z. Boughaleb, N. Z. Bouchbika, N. Benchakroun, H. Jouhadi, S. Sahraoui, A. Benider
MOHAMMED VI Cancer Treatment Center, Radiation Oncology Department, Ibn Rochd University Hospital, Morocco.
MOHAMMED VI Cancer treatment Center,
Radiation Oncology Department,
Ibn Rochd University Hospital, Morocco.
Article Type : Case Report
Received: July 11, 2015; Accepted: August 21, 2015; Published: September 01, 2015
Citation: A. Hassouni et al., (2015) Gastric Cancer with Situs Inversus. Int J Cancer Stud Res. 4(5), 86-87. doi: dx.doi.org/10.19070/2167-9118-1500013.
Copyright: A. Hassouni© 2015. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Situs Inversus; Gastric Cancer.
A male patient, 71 years old, chronic smoker 30 pack years, has presented four months before his consultation, epigastric pain without vomiting or gastro-intestinal bleeding, evolving in a context of weakness with weight loss of 15 Kg in 4 months. Physical examination revealed an altered patient (WHO performance status 2), weighing 48 Kg, abdominal palpation found no abnormalities and examination of lymph nodes areas including supra-clavicular was normal. The Esogastroduodenoscopy showed a vegetating tumor located in the gastric corpus and antrum, the biopsy concluded at a morphological and immunohistochemical aspect of gastric adenocarcinoma. The thoracic-abdominal-pelvic CT showed an incomplete situs inverus with a left liver, right stomach and right cecum, the inferior vena cava was located in the left side of the aorta (Figure A;B). The posterior corpus and fundus wall of the stomach showed diffuse thickening with presence of ascites and signs of peritoneal carcinomatosis without liver metastases and without deep abdominal lymphadenopathy. The chest organs were in their usual position. Ascites fluid cytology revealed neoplastic cells from glandular gastric origin. Due to the peritoneal carcinomatosis, only palliative chemotherapy was indicated.
Situs Inversus is a rare congenital condition that occurs at incidence of 1 in 4000 to 8000 people  in which abdominal and/ or chest organs are positioned at a “Mirror image” of the normal position, in the sagittal plane. There is no evidence relationship between situs inversus and gastric cancer and there are no reports about gastric cancer incidence rates in this situation , however, some cases of malignant neoplasms (Especially gastric and colorectal cancers) were reported. The Japanese Gastric Cancer Treatment Guidelines recommend Gastrectomy and D1+ lymph node dissection as a standard treatment . However, no surgery was performed for our patient because of the metastatic disease.
There is no direct relationship between the situs inversus and stomach cancer. The management of the metastatic disease does not change, however, in the localized stage, the surgical approach and the surgical technique are different compared to a normal anatomical stomach position.
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- Yoshida Y, Saku M, Masuda Y, Maekawa S, Ikejiri K, et al. (1992) Total gastrectomy for gastric cancer associated with situs inversus totalis. A report of 2 cases. S Afr J Surg 30(4): 156-158.
- Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2): 113-123.