Clin Endosc.  2013 Nov;46(6):666-670.

A Case of Early Gastric Cancer with Solitary Metastasis to the Pleura

• Hwang EJ
• Jang JY
• Kim YW
• Dong SH
• Kim HJ
• Kim BH
• Chang YW

Abstract

The incidence of early gastric cancer (EGC) has increased to >50% in Korea owing to a higher detection rate caused by rapid advances in diagnostic instrumentation. EGC with distant metastasis has been rarely reported. Here, we report the case of a 76-year-old woman in whom general EGC was initially diagnosed by endoscopy and endoscopic ultrasonography. She subsequently underwent endoscopic submucosal dissection (ESD). Histological examination of the ESD specimen revealed that neoplastic cells were located predominantly in the submucosal layer and submucosal lymphatic channels. Metastatic cancer cells were also found in the pleural effusion. After conducting all analyses, including immunohistochemical staining, we concluded that the patient had primary EGC with pleural metastasis.

Keyword

Neoplasm metastasis; Stomach neoplasms; Pleura; Lymphatic metastasis

MeSH Terms

Aged
Endoscopy
Endosonography
Female
Humans
Incidence
Korea
Lymphatic Metastasis
Neoplasm Metastasis*
Pleura*
Pleural Effusion
Stomach Neoplasms*

Figure

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  Fig. 1 Endoscopic image showing a slightly elevated lesion (4 cm) with multiple shallow erosions, no definite ulcer scar, and bridging or converging folds over the anterior wall of the antrum.

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  Fig. 2 (A, B) Endoscopic ultrasonographic image showing that the diffuse thickened hypoechoic lesion was limited to the muscularis mucosa, with no irregular narrowing or budding sign.

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  Fig. 3 Chest radiograph obtained after endoscopic submucosal dissection showing left pleural fluid with subsegmental collapse of the left lower lobe.

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  Fig. 4 (A) Histological image of cancer cell infiltration into the lymphatics of the submucosal layer (H&E stain, ×200). (B) Immunohistochemical staining for D2-40 was positive in the lymphatic endothelium and negative in the capillary endothelium (×200).

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  Fig. 5 Cytological findings in the pleural fluid, obtained by thoracocentesis, showing metastatic adenocarcinoma (PAP stain, ×400).

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