Metastatic head and neck carcinoma in a percutaneous gastrostomy site

Two unusual cases of metastatic head and neck carcinoma to the exit site of a percutaneous endoscopic gastrostomy (PEG) tube are reported. These patients presented with squamous cell carcinomas of the supraglottic larynx and oropharynx. In both patients, a PEG tube was inserted using the "pull" technique prior to any extirpative measures. Within 9 months after surgical treatment, each patient was diagnosed with metastatic squamous cell carcinoma at the PEG tube exit site. A review of the literature revealed three cases of metastatic head and neck neoplasms to a PEG site and a single case report of spread to the wound of an "open" gastrostomy. The hematogenous route is the probable mechanism of metastasis, but direct implantation cannot be dismissed. Until further data become available, the authors recommend that, when possible, PEG tube placement using the "pull" technique be deferred until after extirpation of head and neck tumors.