Ann Surg Treat Res.  2014 Jan;86(1):45-49. 10.4174/astr.2014.86.1.45.

Very early-onset peritoneal recurrence following curative total gastrectomy for Borrmann 4 gastric cancer

• Kim DJ
• Lee JH
• Kim W

• KMID: 2266906
• DOI: http://doi.org/10.4174/astr.2014.86.1.45

Abstract

Peritoneal dissemination is one of the treatment failures following gastric cancer surgery. We present a case with very early peritoneal recurrence, detected 8 days following curative surgery. A 39-year-old man, with Borrmann-4 advanced gastric cancer with signet ring cell type, underwent curative open total gastrectomy. However, focal peritoneal nodules on the left side of the diaphragmatic surface, which did not exist at the initial operation, were incidentally found during the reoperation for a postoperative intestinal obstruction via a laparoscopic approach. The pathologic result of the biopsied nodule revealed signet ring cell carcinoma. The patient underwent combination chemotherapy for several months without tumor regression. He suffered from intestinal obstruction again due to carcinomatosis peritonei, and died 9 months following initial surgery. Through this case report, we can carefully suspect that very early progression of cancer cells to carcinomatosis can occur in just several days after an operation.

Keyword

Linitis platisca; Stomach neoplasm; Recurrence; Carcinomatosis

MeSH Terms

Adult
Carcinoma
Carcinoma, Signet Ring Cell
Drug Therapy, Combination
Gastrectomy*
Humans
Intestinal Obstruction
Recurrence*
Reoperation
Stomach Neoplasms*
Treatment Failure

Figure

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  Fig. 1 Gastrofiberoscopic findings showed abrupt change in a year. (A) Normal gastric mucosal fold at midbody greater curvature side 1 year ago, (B) Diffuse thickening of the gastric mucosal folds and cent ral ulceration.

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  Fig. 2 Computed tomography shows diffuse gastric wall thickening suggesting Borrmann-4 gastric cancer.

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  Fig. 3 Positron emission tomography-computed tomography shows equivocal hypermetabolic lesion at the sacroiliac joint (arrow).

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  Fig. 4 (A) Computed tomography showed dilatation of roux-limb. (B) Upper Gastrografin gastrointestinal swallowing study showed near complete obstruction of the Roux-limb proximal to the jejunojejunostomy site.

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  Fig. 5 (A) Laparoscopic findings during reoperation revealed whitish multifocal nodules at the left side of the diaphragm. (B) Histologic finding for peritoneal biopsy revealed signet ring cell type malignant cells infiltrated into muscle tissue.

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