title: Gastric cancer with multiple intramural metastases and metastasis to the small intestine which eventually developed Trousseau's syndrome: report of a case.
abstract: Here we report a rare case of Trousseau's syndrome in a patient with gastric cancer with multiple intramural metastases and metastasis to the small intestine. A 70 year-old male complaining of appetite loss and weight loss of 7 kg within 3 months was admitted to hospital. Esophagogastroduodenal endoscopy revealed an advanced gastric cancer at the pylorus almost occluding the outlet of the stomach, and multiple ulcerative lesions throughout the stomach. A biopsy showed poorly differentiated adenocarcinoma. The patient underwent total gastrectomy. During surgery, part of the distal ileum was found to be abnormally firm and approximately 1 m of the ileum with the cecum colon was resected. Pathologic examination confirmed poorly differentiated adenocarcinoma at the pylorus and multiple intramural metastases in most other areas of the stomach. Lymph node metastases were confirmed in 12 out of 40 harvested regional lymph nodes including one positive paraaortic lymph node. The resected ileum contained multiple tumors with ulceration. Massive lymphatic invasion in the stomach and the small intestine was observed, which strongly suggested lymphatic spread of the gastric cancer. The patient was discharged on post-operative day 21; however, 2 months after surgery, he developed multiple cerebral thromboembolisms and died 2 weeks later.
authors.affiliation: Department of Surgery, Koshigaya Municipal Hospital, Higashikoshigaya 10-47-1, Koshigayashi, Saitama, 343-8577, Japan, hkamiya@juntendo.ac.jp.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kamiyama
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Ichikawa
authors.forename: Shuei
authors.initials: S
authors.lastname: Arima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sugiyama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takei
authors.forename: Koji
authors.initials: K
authors.lastname: Namekata
authors.forename: Hidenori
authors.initials: H
authors.lastname: Tsumura
authors.forename: Masaru
authors.initials: M
authors.lastname: Takase
authors.forename: Motoi
authors.initials: M
authors.lastname: Okada
authors.forename: Fumio
authors.initials: F
authors.lastname: Matsumoto
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000556:secondary*; D000368:Aged; D017809:Fatal Outcome; D006801:Humans; D007078:Ileal Neoplasms / Q000150:complications* / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology*; D013577:Syndrome; D013923:Thromboembolism / Q000209:etiology*