Journal of Medical Science And clinical Research | 2021
A Rare Case Report on Lipodystrophy of Perinodal Adipose Tissue Mimicking Metatstatic Signet Ring Cell Adenocarcinoma in a Cachexic Patient
Abstract
Cachexia is a complex syndrome and a comorbid condition commonly associated with a variety of chronic diseases like cancer, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease and AIDS cancer. It results from metabolic dysregulation and is characterized by profound loss of adipose tissue and skeletal muscles. Approximately 20% of deaths in cancer patients are due to cachexia. Adipose tissue after undergoing cachectic dystrophy may mimics signet ring cell morphology histologically. Such lipodystrophied adipocytes mimicking signet ring cells are a diagnostic pitfall. We present a case of 54 years old male presenting with complains of pain upper abdomen for 1.5 years along with dysphagia and vomiting for last 4-5 months, diagnosed as moderately differentiated adenocarcinoma, biopsy pyloric stricture with metastatic tumor deposits in omental lymph node and lipodystrophy of adipocytes in the perinodal tissue. Case History 54 years old male resident of Himachal Pradesh presented with complains of pain upper abdomen for 1.5 years along with dysphagia and vomiting for last 4-5 months in the surgery OPD. On Examination Patient had cachexia along with pallor. Per abdomen findings included tenderness on deep palpation in the epigastric region. Investigations CT abdomen was performed which was suggestive of gastric outlet obstruction caused by stricture at the pyloric antrum due to peptic ulcer disease. An endoscopy done three days later revealed an ulcer along with stricturous narrowing of the pyloric antrum. Biopsy In view of chronic gastric ulcer disease vagotomy was performed and surgical specimens were sent for HPE which included omental lymph nodes, common hepatic lymph nodes, part of omentum, anterior and posterior vagus and biopsy from the stricture, pylorus. Microscopic Examination Biopsy pylorus revealed denuded muscosal epithelium along with surface fibrinopurulent exudate and an invasive malignant tumor arranged as variably sized and shaped glands, nests and http://jmscr.igmpublication.org/home/ ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v9i6.32