Nakamura Yoshitaka, Yubakami Masayuki, Kondo Yutaka, Nishimura Yukihisa, Todo Momoko, Atsuji Kiyoto, Yamaguchi Akihiro, Kakihara Naoki, Ikawa Osamu, Taniguchi Hiroki
Dept. of Surgery, Japanese Red Cross Kyoto Daini Hospital.
Gan To Kagaku Ryoho. 2018 Mar;45(3):536-538.
A 74-year-old man was referred to our hospital for further investigation of a cystic lesion in the pancreatic body, which had been detected by ultrasonography at a local hospital. He was diagnosed as intraductal papillary mucinous neoplasm(IPMN) and further preoperative examinations were conducted. Upper gastrointestinal endoscopy demonstrated a type 0-II c tumor of the greater curvature in the upper third of the stomach. Endoscopic ultrasonography showed no sign of submucosal invasion. Endoscopic submucosal dissection(ESD)was carried out and pathological examination of a specimen revealed well differentiated adenocarcinoma with submucosal invasion, which fulfilled the indication for additional gastrectomy with lymph node dissection. Laparoscopy-assisted proxymal gastrectomy with D1 plus lymph node dissection and distal pancreatectomy with splenectomy was performed. Pathological examination demonstrated intraductal papillary mucious adenoma(IPMA)in the pancreatic body and no residual gastric cancer in a specimen, however 7lymph node metastases from gastric cancer was confirmed(pN3a), including 3 metastatic lymph nodes incidentally-detected adjacent to the pancreatic parenchyma. We report a rare case of early gastric cancer with N3 lymph node metastases, with a brief literature review.
一名74岁男性因当地医院超声检查发现胰体部囊性病变而转诊至我院作进一步检查。他被诊断为导管内乳头状黏液性肿瘤（IPMN），并进行了进一步的术前检查。上消化道内镜检查显示胃上1/3大弯侧有0-II c型肿瘤。内镜超声检查未发现黏膜下浸润迹象。遂行内镜黏膜下剥离术（ESD），标本病理检查显示为高分化腺癌伴黏膜下浸润，符合追加胃癌根治术及淋巴结清扫术的指征。实施了腹腔镜辅助近端胃癌根治术（D1 + 淋巴结清扫）及远端胰腺切除术（脾切除术）。病理检查显示胰体部为导管内乳头状黏液腺瘤（IPMA），标本中无残留胃癌，但证实有7处胃癌淋巴结转移（pN3a），包括偶然发现的3个紧邻胰腺实质的转移淋巴结。我们报告了一例罕见的伴有N3淋巴结转移的早期胃癌病例，并进行简要文献复习。
