title: A case of mucosal cancer of the stomach treated by endoscopic submucosal dissection after which nodal metastasis became evident.
abstract: An 82-year-old male was referred to our institution for evaluation and treatment of a protruding lesion in the stomach. Esophagogastroduodenoscopy (EGD) showed a small protruding lesion and a large superficial elevated lesion on the lesser curvature of the stomach (macroscopic type: 0-I and 0-IIa, resp.). CT and endoscopic ultrasonography (EUS) visualized a small round lymph node (LN) 11 mm in size near the lesser curvature, although submucosal invasion was not evident. These two lesions were resected en bloc by endoscopic submucosal dissection (ESD). Pathological examination of the resected specimen showed moderately differentiated tubular adenocarcinoma (tub2) and well-differentiated tubular adenocarcinoma (tub1), respectively, which were limited to the mucosal layer. Because lymphatic-vascular involvement was not detected by hematoxylin and eosin (HE) staining, additional gastrectomy was not performed. Two months after ESD, follow-up EUS and CT showed an enlarged LN. EUS-guided fine needle aspiration (EUS-FNA) for the LN revealed metastasis. Therefore, total gastrectomy with LN dissection was performed. His postoperative course was uneventful. After discharge, he has been followed up at the outpatient department without any sign of recurrence for 5 years. Histological reexamination of the ESD specimen using immunohistochemistry showed lymphatic invasion of cancer cells in the lamina propria of the 0-I lesion 13 mm in size.
authors.affiliation: Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai 983-0824, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Obana
authors.forename: Naotaka
authors.initials: N
authors.lastname: Fujita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Noda
authors.forename: Dai
authors.initials: D
authors.lastname: Hirasawa
authors.forename: Kei
authors.initials: K
authors.lastname: Ito
authors.forename: Toshiki
authors.initials: T
authors.lastname: Sugawara
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Harada
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Oohira
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
authors.forename: Takashi
authors.initials: T
authors.lastname: Sawai