title: Single skip metastasis in sentinel lymph node: In an early gastric cancer.
abstract: Lymph node status is considered a key prognostic and predictive factor in patients with gastric cancer (GC). Although there is a practical approach to the intraoperative detection of sentinel lymph nodes (SLNs), such a procedure is not included in the European surgical protocol. In this report, we present a practical approach to SLN mapping in a representative case with early gastric cancer (EGC). A 74-year-old female was hospitalized with an endoscopically observed, superficially ulcerated tumor located in the antral region. Subtotal gastrectomy with D2 lymphadenectomy and SLN mapping was performed by injecting methylene blue dye into the peritumoral submucosal layer. An incidentally detected blue-stained lymph node located along the middle colic artery was also removed. This was detected 40 min after injection of the methylene blue. Histopathologic examination showed a pT1b-staged well-differentiated HER-2-negative adenocarcinoma. All of the 41 LNs located at the first, third, and fifth station of the regional LN compartments were found to be free of tumor cells. The only lymph node with metastasis was located along the middle colic artery and was considered a non-regional lymph node. This incidentally identified skip metastasis indicated stage IV GC. A classic chemotherapy regimen was given, and no recurrences were observed six months after surgery. In this representative case, low-cost SLN mapping, with a longer intraoperative waiting time, totally changed the stage of the tumor in a patient with EGC.
authors.affiliation: Tivadar Jr Bara, Tivadar Bara, Department of Surgery, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania.
authors.forename: Tivadar
authors.initials: T
authors.lastname: Bara
authors.affiliation: Tivadar Jr Bara, Tivadar Bara, Department of Surgery, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Gurzu
authors.affiliation: Tivadar Jr Bara, Tivadar Bara, Department of Surgery, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania.
authors.forename: Ioan
authors.initials: I
authors.lastname: Jung
authors.affiliation: Tivadar Jr Bara, Tivadar Bara, Department of Surgery, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Kadar
authors.affiliation: Tivadar Jr Bara, Tivadar Bara, Department of Surgery, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sugimura
authors.affiliation: Tivadar Jr Bara, Tivadar Bara, Department of Surgery, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania.
authors.forename: Tivadar
authors.initials: T
authors.lastname: Bara
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000368:Aged; D002454:Cell Differentiation; D017024:Chemotherapy, Adjuvant; D004396:Coloring Agents / Q000008:administration & dosage; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007267:Injections; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008751:Methylene Blue / Q000008:administration & dosage; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue
keywords: Early gastric cancer; Lymph node metastasis; Middle colic artery; Sentinel lymph node; Skip metastasis