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Gastric Cancer

, Volume 11, Issue 1, pp 53–58 | Cite as

Two rare cases of node-positive differentiated gastric cancer despite their infiltration to sm1, their small size, and lack of lymphatic invasion into the submucosal layer

  • Hideki Nagano
  • Shigekazu Ohyama
  • Tetsu Fukunaga
  • Naoki Hiki
  • Yasuyuki Seto
  • Toshiharu Yamaguchi
  • Yo Kato
  • Akio Yamaguchi
Case Report

Abstract

Early gastric cancer without lymph node metastasis has been reported after the analysis of many cases, and a consensus has been reached about this condition. We report two cases of node-positive differentiated sm1 gastric cancer without lymphatic invasion into the submucosal layer. Case 1 was a 73-year-old man who underwent EMR for 0-IIc early gastric cancer (EGC) on the gastric angle, with a histological diagnosis of tub1. Pathological examination revealed a 0-IIc lesion that was 12 mm in size and sm1 in invasion depth without lymphatic-vascular invasion. However, the infiltration in the submucosal layer was relatively wide. The patient subsequently underwent distal gastrectomy with D2 lymph node dissection. Pathological examination revealed level 2 lymph node metastasis. Case 2 was a 62-year-old woman who underwent ER for a 0-I+IIc-type EGC on the greater curvature of the antrum, with a histological diagnosis of tub1. Pathological examination revealed a 0-I+IIc-type lesion that was 15 mm in size and sm1 in depth. Lymphatic invasions in the muscularis mucosa were found, but none were seen in the submucosal layer. Two years later, follow-up computed tomography (CT) showed a lymph node swelling in the infrapyloric region. Distal gastrectomy with D2 dissection was then performed, and pathological examination revealed level 1 lymph node metastasis. Although the lesions in both patients satisfied the criteria of Gotoda et al. for minimal risk of nodal involvement, lymph node metastasis was observed in these patients. Curative surgery with lymph node dissection is thus required in patients with wide infiltration of the submucosal layer or lymphatic invasion in the muscularis mucosa.

Key words

Gastric cancer sm1 Infiltration depth Lymph node metastasis 

References

  1. 1.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000;3:219–225.PubMedCrossRefGoogle Scholar
  2. 2.
    Nagano H, Ohyama S, Fukunaga T, Hiki N, Seto Y, Yamaguchi T, et al. Two rare cases of node-positive differentiated gastric cancer despite their infiltration to sm1, their small size, and lack of lymphatic invasion into the submucosal layer. Gastric Cancer 2008;11:53–58.CrossRefPubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2008

Authors and Affiliations

  • Hideki Nagano
    • 1
    • 3
  • Shigekazu Ohyama
    • 1
  • Tetsu Fukunaga
    • 1
  • Naoki Hiki
    • 1
  • Yasuyuki Seto
    • 1
  • Toshiharu Yamaguchi
    • 1
  • Yo Kato
    • 2
  • Akio Yamaguchi
    • 3
  1. 1.Department of SurgeryCancer Institute Hospital of JFCRTokyoJapan
  2. 2.Department of PathologyCancer Institute Hospital of JFCRTokyoJapan
  3. 3.First Department of Surgery, Faculty of MedicineUniversity of FukuiFukuiJapan

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