Abstract
Late onset of peritoneal recurrence of gastric cancer more than 10 years after surgery is extremely rare, and only three cases have been reported. We present the case of a 61-year-old man who was diagnosed finally with peritoneal recurrence of gastric cancer 20 years after primary curative resection. As a result of small-bowel obstruction caused by peritoneal recurrence, diverting ileostomy with partial ileal resection was performed. The resected specimen revealed tubular adenocarcinoma that resembled the primary gastric cancer. The clinical course after the second operation was unfavorable and systemic chemotherapy had no effect. He died at 62 years of age, 21 years and 7 months after initial gastrectomy. Immunohistochemical analysis using antibodies against proliferating cell nuclear antigen (PCNA), Ki-67, and p53 was performed to investigate the phenotype of primary and recurrence cancer. Protein expression of proliferation markers such as PCNA and Ki-67 was down-regulated, but p53 was overexpressed at the site of recurrence. These data suggest that late peritoneal recurrence has a low proliferation rate and is resistant to chemoradiotherapy. In conclusion, we present late onset of peritoneal recurrence of gastric cancer more than 20 years after primary surgery, and speculate on the mechanism of late-onset recurrence in our case.
Highlights
Gastric cancer is a leading cause of tumor-related deaths, with approximately 50,000 individuals dying of gastric cancer each year in Japan
We report a case of peritoneal recurrence of gastric cancer that occurred more than 20 years after curative surgery, and review previous reports of these cases
* Correspondence: kusunoki@clin.medic.mie-u.ac.jp Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan we investigated how expression of several proteins, such as proliferating cell nuclear antigen (PCNA), Ki67, and p53, differ between primary and secondary resection samples, and speculate on the mechanism of late-onset recurrence in our case
Summary
Gastric cancer is a leading cause of tumor-related deaths, with approximately 50,000 individuals dying of gastric cancer each year in Japan. Radiographic contrast enema and colonoscopy could not evaluate the patient adequately because of extrinsic compression of the sigmoid colon Tumor markers such as carcinoembryonic antigen, gastrointestinal cancer antigen 19-9, and alpha-fetoprotein were within normal limits. The immunohistochemical staining for cytokeratin-7 (CK-7; 1:50; DAKO, Glostrup, Denmark) was not expressed both in primary and disseminated cancer cells (Figure 2b and 2c). Immnohistochemical staining for CK-20 (1:25; DAKO, Glostrup, Denmark) was not expressed both in primary and disseminated 6cancer cells (Figure 2d and 2e). Systemic reevaluation, including total colonoscopy and systemic computed tomography, could not confirm another primary tumor as the cause of the recurrence, peritoneal recurrence of gastric cancer more than 20 years after primary surgery was diagnosed. The patient’s general condition after secondary surgery took a gradual turn for the worse, despite 5-fluorouracilbased systemic chemotherapy, and he died at 62 years of age, 21 years and 7 months after initial gastrectomy
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