Early Gastric Cancer Accompanied with a Giant Metastatic Abdominal Lymph Node

Park, Jong Woo; Lee, Sang Kuon; Kim, Won Woo; Jeon, Hae Myung; Kim, Eung Kook

Abstract

Lymph node metastasis is found in 10-15% of patients with early gastric cancer; however, metastatic nodes forming giant abdominal masses or distant metastases are extremely rare. A 51-year-old male, HBs Ag-positive patient presented with an incidentally found huge upper abdominal mass. Imaging studies showed a 7 cm-sized epigastric mass consistent with hepatocellular carcinoma. His serum -fetoprotein level was also significantly elevated (330.6 ng/ml). Endoscopic studies revealed a suspicious early gastric carcinoma located on the lesser curvature and the anterior wall of the antrum. He was operated on with a preoperative diagnosis of hepatocellular carcinoma coexisting with an early gastric carcinoma. However, the actual abdominal tumor was a metastatic lymph node resulting from a gastric carcinoma which was located around the hepatic artery. Accordingly, he underwent a subtotal gastrectomy with the D2 lymph node dissection and the removal of the metastatic node. Postoperatively, he did well without any complications. His serum -fetoprotein level decreased to 49.3 ng/ml one week after the surgery and was completely normalized 3 months later. To date, one year and 4 months after the operation, he is in good conditions without evidence of recurrence on endoscopic and imaging studies.