Clin Endosc.  2015 May;48(3):247-250. 10.5946/ce.2015.48.3.247.

Liver Metastasis of Early Gastric Cancer with Mixed Histology after Endoscopic Submucosal Dissection

• Han YH
• Park JK
• Kwon JS
• Kim YD
• Jeong WJ
• Lee SJ
• Han KH
• Cheon GJ

• KMID: 2148574
• DOI: http://doi.org/10.5946/ce.2015.48.3.247

Abstract

The Japanese Classification of Gastric Carcinoma histologically classifies endoscopically resected gastric cancer into differentiated and undifferentiated types according to the presence or absence of tubular structures on histology. The former includes papillary adenocarcinoma and tubular types, and the latter includes poorly differentiated adenocarcinoma, signet ring cell carcinoma and mucinous adenocarcinoma. However, gastric cancer sometimes contains a mixture of differentiated and undifferentiated components, and the clinical outcomes of the histological mixture are unknown, especially following endoscopic resection of early gastric cancer (EGC). This case was within the guideline indications for endoscopic submucosal resection (ESD), although it contained a partly signet ring cell carcinoma component; it recurred after 19 months with multiple lymph node and liver metastases. This case shows that additional surgical resection after ESD should be performed for patients with any mixed signet ring cell component, even in mild or moderately differentiated EGC.

Keyword

Early gastric cancer; Mixed histology; Endoscopic submucosal dissection

MeSH Terms

Adenocarcinoma
Adenocarcinoma, Mucinous
Adenocarcinoma, Papillary
Asian Continental Ancestry Group
Carcinoma, Signet Ring Cell
Cellular Structures
Classification
Humans
Liver*
Lymph Nodes
Neoplasm Metastasis*
Stomach Neoplasms*

Figure

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  Fig. 1 Esophagogastroduodenoscopy showing IIa+IIc lesions on the posterior wall of the mid-antrum.

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  Fig. 2 En bloc esophagogastroduodenoscopy specimen; the carcinoma is confined within the red line.

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  Fig. 3 Pathologic findings. (A) Moderately differentiated area with signet ring cell features invades into the muscularis mucosa (H&E stain, ×100). (B) A clear vertical resection margin (H&E stain, ×100).

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  Fig. 4 Abdominal computed tomography findings. (A) A 3×5-cm necrotic mass (arrows) between the prepyloric antrum and pancreas head. (B) A 1.5-cm ill-defined mass (arrow) in segment 7 of the liver.

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  Fig. 5 Liver biopsy. A moderately differentiated adenocarcinoma with signet ring cell features compatible with liver metastasis of early gastric cancer (H&E stain, ×100).

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