Clin Endosc.  2019 Jul;52(4):369-372. 10.5946/ce.2018.130.

A Rare Case of Lymph Node Metastasis from Early Gastric Cancer

• Yoshikawa
• Kadokawa Y
• Ohana M
• Fukuda A
• Seno H

• KMID: 2455635
• DOI: http://doi.org/10.5946/ce.2018.130

Abstract

Gastric cancers that fulfill the Japanese criteria for curative endoscopic resection show a low risk of lymph node (LN) metastasis. Here, we report a case of LN metastasis from early gastric cancer that fulfilled the curative criteria. A 74-year-old Japanese woman was referred to our hospital for treatment of early gastric cancer identified at the site of a hyperplastic polyp that had been diagnosed 10 years prior to presentation. Contrast-enhanced computed tomography did not show any lymphadenopathy and laparoscopy-assisted distal gastrectomy was performed. Histopathological examination revealed a predominantly moderately differentiated adenocarcinoma that measured 15 mm in size and was confined to the mucosa. However, a single metastatic regional LN was observed. A few cancer cells showed positive staining for alpha-fetoprotein. It should be noted that early gastric cancer can be accompanied by LN metastasis even if it fulfills the criteria for curative endoscopic resection.

Keyword

Early gastric cancer; Lymph node metastasis; Alpha-fetoproteins; Gastric hyperplastic polyp; Endoscopic resection

MeSH Terms

Adenocarcinoma
Aged
alpha-Fetoproteins
Asian Continental Ancestry Group
Female
Gastrectomy
Humans
Lymph Nodes*
Lymphatic Diseases
Mucous Membrane
Neoplasm Metastasis*
Polyps
Stomach Neoplasms*
alpha-Fetoproteins

Figure

• 

  Fig. 1. Image shows a gastric hyperplastic polyp identified 10 years prior to the initiation of treatment. (A) Esophagogastroduodenoscopic image shows a reddish pedunculated polyp on the posterior antral wall of the stomach. (B) The biopsy specimen obtained from the polyp shows hyperplastic foveolar epithelium (hematoxylin and eosin, ×4).

• 

  Fig. 2. Images show early gastric cancer observed at the time of treatment. (A) An esophagogastroduodenoscopic image shows a type 0-I adenocarcinoma at the site of the previously identified hyperplastic polyp. (B) A contrast-enhanced computed tomographic image does not show any lymph node enlargement.

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  Fig. 3. Histopathological findings of the primary lesion. (A) The resected specimen shows a type 0-I adenocarcinoma measuring 15 mm in size that is confined to the mucosal layer (hematoxylin and eosin [H&E], ×1). (B) The specimen predominantly shows a moderately differentiated adenocarcinoma (H&E, ×200). (C) The specimen shows a small poorly differentiated component (H&E, ×400). (D) The specimen shows a small segment of residual hyperplastic epithelium (H&E, ×200). (E) Immunohistochemical examination shows a few cancer cells stained positively for alpha-fetoprotein (H&E, ×100).

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  Fig. 4. Image shows a metastatic lymph node with features of a moderately differentiated adenocarcinoma (hematoxylin and eosin, A ×40 and B ×400).

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