Cancer Res Treat.  2015 Jan;47(1):120-125. 10.4143/crt.2013.137.

MET-Amplified Intramucosal Gastric Cancer Widely Metastatic after Complete Endoscopic Submucosal Dissection

• Lee D
• Kim YC
• Lee KM
• Yoon JK
• Kim YB

• KMID: 2380398
• DOI: http://doi.org/10.4143/crt.2013.137

Abstract

Intramucosal gastric cancer (IGC) is associated with a very low risk of lymph node metastasis; thus it is the main candidate for minimally invasive surgical procedures, such as endoscopic submucosal dissection (ESD). Herein, we document an extraordinary case of IGC, which showed a very aggressive clinical course. A 66-year-old female underwent ESD for early gastric cancer. Histologically, the tumor consisted mainly of moderately differentiated adenocarcinoma measuring 1.6 cm in diameter, and the tumor was confined to the mucosa. Despite annual esophagogastroduodenoscopic follow-up, the tumor recurred, with wide metastasis to multiple lymph nodes and bones throughout the body after three years. Fluorescence in situ hybridization study demonstrated MET gene amplification as well as low grade polysomy 7 in both original and recurrent tumors. The clinical characteristics of metastatic IGCs and the implication of MET amplification are discussed.

Keyword

Early gastric cancer; MET amplification; Metastasis

MeSH Terms

Adenocarcinoma
Aged
Female
Fluorescence
Follow-Up Studies
Gene Amplification
Humans
In Situ Hybridization
Lymph Nodes
Mucous Membrane
Neoplasm Metastasis
Stomach Neoplasms*
Surgical Procedures, Minimally Invasive

Figure

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  Fig. 1. (A, B) The specimen from endoscopic submucosal dissection shows a slightly depressed lesion in the lower central portion. Histologically confirmed maximum tumor diameter is 1.6 cm. (C) The main histologic type of the tumor is moderately differentiated adenocarcinoma. The tumor does not touch the muscularis mucosa (H&E staining, ×100).

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  Fig. 2. (A) Recurrent tumor consists mainly of poorly differentiated adenocarcinoma (H&E staining, ×200). (B) Several lymphatic tumor emboli are identified even in the biopsy tissues (H&E staining, ×200).

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  Fig. 3. (A) Abdominal computed tomography shows tumor recurrence in the antrum of the stomach (arrow). The tumor appears as an advanced gastric cancer. (B, C) Positron emission tomography scan shows extensive lymph node and skeletal metastases.

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  Fig. 4. Representative images of fluorescence in situ hybridization study from the original tumor show definite MET gene amplification (red signal) as well as low grade polysomy 7 (green signal).

Reference

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