Kamiya Ayako, Katai Hitoshi, Ishizu Kenichi, Wada Takeyuki, Hayashi Tsutomu, Otsuki Sho, Yamagata Yukinori, Yoshikawa Takaki, Sekine Shigeki, Nishi Tomohiko, Kawasaki Yuka, Ito Takafumi, Domoto Hideharu
Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Surg Case Rep. 2021 Jan 6;7(1):5. doi: 10.1186/s40792-020-01089-0.
Endoscopic submucosal dissection (ESD) is gaining ground as a minimally invasive treatment for early gastric cancer (EGC) that has a negligible risk of lymph node metastasis. According to the 5th edition of Japanese gastric cancer treatment guidelines, annual or biannual follow-up with endoscopy is recommended, but follow-up with abdominal ultrasonography or computed tomography (CT) for surveillance of metastases is not recommended after the eCuraA resection. However, we experienced a case of lymph node recurrence following ESD resulting in eCuraA.
A 76-year-old female received ESD for EGC in a previous hospital 4 years ago. Pathological findings were tub1, 30 mm, T1a (M), UL0, Ly0, V0, pHM-, pVM- (eCuraA) according to the 15th edition of Japanese Classification of Gastric Carcinoma. Follow-up esophagogastroduodenoscopy revealed submucosal tumor, which was suspected as a swollen lymph node by CT and endoscopic ultrasound fine-needle aspiration revealed the recurrence of gastric cancer. We performed total gastrectomy with D2 lymph node dissection. Postoperative pathological examination revealed no local recurrent tumor at the ESD site in the stomach. Swollen lymph node was diagnosed as metastasis and lymph node metastasis was limited near the cardia.
This case provides valuable information about tumor with a minimum poorly differentiated adenocarcinoma component may develop lymph node metastasis even satisfying the guidelines criteria for curative resection.
内镜黏膜下剥离术（ESD）作为早期胃癌（EGC）的一种微创治疗方法正逐渐得到广泛应用，其淋巴结转移风险可忽略不计。根据日本胃癌治疗指南第5版，建议每年或每两年进行一次内镜随访，但在eCuraA切除术后，不建议采用腹部超声或计算机断层扫描（CT）进行转移灶监测随访。然而，我们遇到了一例ESD术后发生淋巴结复发导致eCuraA的病例。
一名76岁女性4年前在之前的医院接受了EGC的ESD治疗。根据日本胃癌分类第15版，病理结果为tub1，30mm，T1a（M），UL0，Ly0，V0，pHM-，pVM-（eCuraA）。随访食管胃十二指肠镜检查发现黏膜下肿瘤，CT怀疑为肿大淋巴结，内镜超声细针穿刺显示胃癌复发。我们进行了D2淋巴结清扫的全胃切除术。术后病理检查显示胃ESD部位无局部复发性肿瘤。肿大淋巴结被诊断为转移，且淋巴结转移局限于贲门附近。
本病例提供了有价值的信息，即即使肿瘤符合治愈性切除的指南标准，但只要含有最小程度的低分化腺癌成分，仍可能发生淋巴结转移。
