A case of undifferentiated-type mucosal gastric cancer with multiple lymph node metastases fulfilling the curative criteria for endoscopic resection according to routine pathological analysisReport as inadecuate




A case of undifferentiated-type mucosal gastric cancer with multiple lymph node metastases fulfilling the curative criteria for endoscopic resection according to routine pathological analysis - Download this document for free, or read online. Document in PDF available to download.

Surgical Case Reports

, 2:96

First Online: 13 September 2016Received: 26 July 2016Accepted: 05 September 2016

Abstract

BackgroundEndoscopic resection is accepted as the standard treatment for early mucosal gastric cancer, and its indications have recently been expanded while its long-term outcomes are still unclear. Herein, we present a didactic case of undifferentiated-type mucosal gastric cancer fulfilling the expanded indication and curative criteria for endoscopic submucosal dissection ESD, having synchronous multiple lymph node metastases.

Case presentationA 40-year-old woman was found to have a Helicobacter pylori infection at a standard health check with no abdominal symptoms. She received an upper gastrointestinal endoscopy and found to have an undifferentiated-type mucosal gastric cancer with the size of 15 mm in diameter without ulceration, which fulfilled the expanded indication for ESD. According to patient’s preference, we performed laparoscopy-assisted distal gastrectomy with D1+ lymph node dissection, and routine pathological analysis revealed a predominantly signet ring cell carcinoma limited to the mucosa without ulceration or any vessel involvement; on the other hand, 15 lymph node metastases were detected. Then, we added deep sectioning of the whole tumoral area at a thickness of 20 μm and immunohistochemical analyses. As the result, an isolated lymphatic capillary involvement of the extremely superficial submucosa was identified in a single histological section, and pathological diagnosis was corrected to ly1. She received postoperative adjuvant chemotherapy with an S-1 oral agent and had no recurrence under strict surveillance for 1 year postoperatively.

ConclusionsWhen we perform ESD for undifferentiated-type gastric cancer, deep sectioning of the whole tumoral area into thin slices and immunohistochemical staining using D2-40 should be practically considered.

KeywordsUndifferentiated-type gastric cancer Endoscopic submucosal dissection Lymph node metastasis AbbreviationsESDEndoscopic submucosal dissection

HandEHematoxylin and eosin

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Author: Takao Hara - Tsuyoshi Etoh - Yoshitake Ueda - Yuki Shitomi - Hidefumi Shiroshita - Norio Shiraishi - Tsutomu Daa - Masafumi

Source: https://link.springer.com/article/10.1186/s40792-016-0225-7







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