Abstract
BackgroundEndoscopic resection is accepted as the standard treatment for early mucosal gastric cancer, and its indications have recently been expanded while its long-term outcomes are still unclear. Herein, we present a didactic case of undifferentiated-type mucosal gastric cancer fulfilling the expanded indication and curative criteria for endoscopic submucosal dissection (ESD), having synchronous multiple lymph node metastases.Case presentationA 40-year-old woman was found to have a Helicobacter pylori infection at a standard health check with no abdominal symptoms. She received an upper gastrointestinal endoscopy and found to have an undifferentiated-type mucosal gastric cancer with the size of 15 mm in diameter without ulceration, which fulfilled the expanded indication for ESD. According to patient’s preference, we performed laparoscopy-assisted distal gastrectomy with D1+ lymph node dissection, and routine pathological analysis revealed a predominantly signet ring cell carcinoma limited to the mucosa without ulceration or any vessel involvement; on the other hand, 15 lymph node metastases were detected. Then, we added deep sectioning of the whole tumoral area at a thickness of 20 μm and immunohistochemical analyses. As the result, an isolated lymphatic capillary involvement of the extremely superficial submucosa was identified in a single histological section, and pathological diagnosis was corrected to ly1. She received postoperative adjuvant chemotherapy with an S-1 oral agent and had no recurrence under strict surveillance for 1 year postoperatively.ConclusionsWhen we perform ESD for undifferentiated-type gastric cancer, deep sectioning of the whole tumoral area into thin slices and immunohistochemical staining using D2-40 should be practically considered.
Highlights
ConclusionsWhen we perform endoscopic submucosal dissection (ESD) for undifferentiated-type gastric cancer, deep sectioning of the whole tumoral area into thin slices and immunohistochemical staining using D2-40 should be practically considered
Endoscopic resection is accepted as the standard treatment for early mucosal gastric cancer, and its indications have recently been expanded while its long-term outcomes are still unclear
We report a case of undifferentiated mucosal gastric cancer with multiple lymph node metastases fulfilling the expanded curative criteria for endoscopic resection according to routine pathological analysis
Summary
The findings of this study indicate that intensive pathological analyses using H&E and D2-40 staining in thin-cut histological sections should be considered in cases of undifferentiated-type gastric cancer, fulfilling the expanded indication for endoscopic resection in order to detect minute lymphatic capillary involvement. 5. Choi KK, Bae JM, Kim SM, Sohn TS, Noh JH, Lee JH, et al The risk of lymph node metastases in 3951 surgically resected mucosal gastric cancers: implications for endoscopic resection. 9. Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, et al Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Hirasawa T, Fujisaki J, Fukunaga T, Yamamoto Y, Yamaguchi T, Katori M, et al Lymph node metastasis from undifferentiated-type mucosal gastric cancer satisfying the expanded criteria for endoscopic resection based on routine histological examination.
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