J Gastric Cancer.  2013 Mar;13(1):65-68.

Perforated Early Gastric Cancer: Uncommon and Easily Missed a Case Report and Review of Literature

• Lim RH
• Tay CM
• Wong B
• Chong CS
• Kono K
• So JB
• Shabbir A

Abstract

Gastric carcinoma rarely presents as a perforation, but when it does, is perceived as advanced disease. The majority of such perforations are Stage III/IV disease. A T1 gastric carcinoma has never been reported to perforate spontaneously in English literature. We present a 56 year-old Chinese male who presented with a perforated gastric ulcer. Intra-operatively, there was no suspicion of malignancy. At operation, an open omental patch repair was performed. Post-operative endoscopy revealed a macroscopic Type 0~III tumour and from the ulcer edge biopsy was reported as adenocarcinoma. Subsequently, the patient underwent open subtotal gastrectomy and formal D2 lymphadenectomy. The final histopathology report confirms T1b N0 disease. The occurrence of a perforated early gastric cancer re-emphasises the need for vigilance, including intra-operative frozen section and/or biopsy, as well as routine post-operative endoscopy for all patients.

Keyword

Stomach neoplasms; Early gastric cancer; Rupture spontaneous; Peritonitis; General surgery

MeSH Terms

Adenocarcinoma
Asian Continental Ancestry Group
Biopsy
Endoscopy
Frozen Sections
Gastrectomy
Humans
Lymph Node Excision
Male
Peritonitis
Stomach Neoplasms
Stomach Ulcer
Ulcer

Figure

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  Fig. 1 Computed tomography of Abdomen and Pelvis, showing gross pneumoperitoneum and likely site of perforation.

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  Fig. 2 (A) An oesophagogastroduodenoscopy 6 weeks postoperative showing tumour along the incisura. (B) Japanese sub-classification of type 0 gastric tumours.

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  Fig. 3 (A) Gross surgical specimen of ulcer/tumour. (B) Close-up view of ulcer and histological mapping of sampled specimen.

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  Fig. 4 Low-magnification picture of the resection specimen, with the submucosal tumour highlighted (H&E, ×20).

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  Fig. 5 (A) Microscopic histology showing focal submucosal invasion, with no tumour cells seen in muscularis propria (H&E, ×40). (B) Magnified view showing tumour cells limited to submucosal layer (H&E, ×200).

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