A case of mixed-type early gastric cancer with recurrence following curative endoscopic submucosal dissection for expanded indication

Abstract

Background and study aims In Japan, intramucosal gastric adenocarcinoma with ulcerative finding having a predominantly differentiated type with an undifferentiated component, tumor diameter ≤ 3 cm, and no lymphovascular invasion is included in the expanded pathological criteria for curative endoscopic treatment. This indication is based on retrospective examination of surgical resection cases, and is determined to have a negligible risk of lymph node metastasis (LNM). We performed endoscopic submucosal dissection on a 78-year-old man with early gastric cancer in 2011, and pathology revealed a well-differentiated tubular adenocarcinoma (21 × 10 mm in diameter), with poorly differentiated adenocarcinoma components, limited to the mucosa, fibrosis by ulcer scar in the submucosal layer, no lymphovascular invasion, and tumor-free margins. Resection was determined to be curative under expanded indications of the gastric cancer treatment guidelines, 4^th edition. However, 55 months after the initial diagnosis, invasive local and distant recurrence was noted. Ultimately, the patient died of gastric cancer 3 months after recurrence.

• References

• 1 Takizawa K, Ono H, Yamamoto Y. et al. Incidence of lymph node metastasis in intramucosal gastric cancer measuring 30 mm or less, with ulceration; mixed, predominantly differentiated-type histology; and no lymphovascular invasion: a multicenter retrospective study. Gastric Cancer 2016; 19: 1144-1148
• 2 Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017; 20: 1-19
• 3 Suzuki H, Oda I, Abe S. et al. High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection. Gastric Cancer 2016; 19: 198-205
• 4 Hasuike N, Ono H, Boku N. et al. A non-randomized confirmatory trial of an expanded indication for endoscopic submucosal dissection for intestinal-type gastric cancer (cT1a): the Japan Clinical Oncology Group study (JCOG0607). Gastric Cancer 2018; 21: 114-123
• 5 Hanaoka N, Tanabe S, Higuchi K. et al. A rare case of histologically mixed-type intramucosal gastric cancer accompanied by nodal recurrence and liver metastasis after endoscopic submucosal dissection. Gastrointest Endosc 2009; 69: 588-590
• 6 Fujii H, Ishii E, Tochitani S. et al. Lymph node metastasis after endoscopic submucosal dissection of a differentiated gastric cancer confined to the mucosa with an ulcer smaller than 30 mm. Dig Endosc 2015; 27: 159-161
• 7 Ochiai T, Ominami M, Nagami Y. et al. Lymph node metastasis of mixed adenoneuroendocrine carcinoma after curative resection using the expanded criteria for early gastric cancer. Intern Med (Tokyo, Japan) 2018; 57: 2837-2842
• 8 Abe S, Oda I, Nakajima T. et al. A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer. Gastric Cancer 2015; 18: 188-192
• 9 Oya H, Gotoda T, Kinjo T. et al. A case of lymph node metastasis following a curative endoscopic submucosal dissection of an early gastric cancer. Gastric Cancer 2012; 15: 221-225
• 10 Sekiguchi M, Oda I, Taniguchi H. et al. Risk stratification and predictive risk-scoring model for lymph node metastasis in early gastric cancer. J Gastroenterol 2016; 51: 961-970