title: A case of lymph node metastasis following a curative endoscopic submucosal dissection of an early gastric cancer.
abstract: Currently in Japan, differentiated gastric submucosal invasive cancers <500 μm (SM1) with negative lymphovascular involvement are included in expanded pathological criteria for curative endoscopic treatment. This is based on a retrospective examination of surgical resection cases in which patients suitable for such expanded criteria were determined to have a negligible risk of lymph node metastasis. We performed endoscopic submucosal dissection on a 65-year-old male with early gastric cancer in April 2005, and pathology revealed a well-differentiated adenocarcinoma, 21 × 10 mm in size, SM1 invasion depth and negative lymphovascular invasion as well as tumor-free margins, so the case was diagnosed as a curative resection. This case, however, resulted in lymph node metastasis that was diagnosed by endoscopic ultrasonography with fine-needle aspiration biopsy in May 2009. Distal gastrectomy with D2 lymph node dissection was then performed, confirming lymph node metastasis from the original gastric cancer.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
authors.forename: Hisaharu
authors.initials: H
authors.lastname: Oya
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.forename: Tetsu
authors.initials: T
authors.lastname: Kinjo
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Suzuki
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Yoshinaga
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kushima
authors.forename: Makoto
authors.initials: M
authors.lastname: Saka
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Katai
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D000368:Aged; D044963:Biopsy, Fine-Needle; D004724:Endoscopy; D019160:Endosonography; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D011859:Radiography; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
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