J Gastric Cancer.  2015 Jun;15(2):139-142. 10.5230/jgc.2015.15.2.139.

Metachronous Liver Metastasis Resulting from Early Gastric Carcinoma after Subtotal Gastrectomy Following Endoscopic Resection: A Case Report

• Oh SJ
• Suh BJ

• KMID: 2372362
• DOI: http://doi.org/10.5230/jgc.2015.15.2.139

Abstract

Hepatic metastasis of early gastric cancer (EGC) following subtotal gastrectomy with lymphadenectomy is rare. We report the case of a 61-year-old male patient who was diagnosed with EGC that was initially treated using endoscopic submucosal dissection (ESD) and subsequently underwent laparoscopic subtotal gastrectomy. Histopathological examination of the patient's ESD specimen showed a moderately differentiated tubular adenocarcinoma invading the submucosa without lymphatic invasion. The deep margin of the specimen was positive for adenocarcinoma, and he subsequently underwent laparoscopic distal gastrectomy. The patient developed liver metastasis 15 months after the operation and then underwent liver resection. Histology of the resected specimen confirmed the diagnosis of two foci of metastatic adenocarcinoma originating from stomach cancer. Immunohistochemical analysis of the specimen demonstrated overexpression of human epidermal growth factor receptor 2. The patient was treated with trastuzumab in combination with chemotherapy consisting of capecitabine and cisplatin. Twenty-four months after the operation, the patient remained free of recurrence.

Keyword

Gastric cancer; Liver meastasis; Endoscopic submucosal dissection

MeSH Terms

Adenocarcinoma
Cisplatin
Capecitabine
Diagnosis
Drug Therapy
Gastrectomy*
Humans
Liver*
Lymph Node Excision
Male
Middle Aged
Neoplasm Metastasis*
Receptor, Epidermal Growth Factor
Recurrence
Stomach Neoplasms
Trastuzumab
Cisplatin
Receptor, Epidermal Growth Factor

Figure

• 

  Fig. 1 Esophagogastroduodenoscopy showing a small superficial elevated lesion in the antrum of the stomach.

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  Fig. 2 Histopathological examination of the specimens resected by endoscopic submucosal dissection revealing tubular adenocarcinoma with submucosal invasion (H&E, × 40).

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  Fig. 3 An abdominopelvic computed tomography scan showing a 3.5-cm-mass in the liver that demonstrated strong enhancement following the intravenous administration of contrast material.

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  Fig. 4 18F-2-deoxy-2-fluoro-D-glucose (FDG) positron emission tomography image showing intense FDG uptake in the liver.

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  Fig. 5 Histology of metastatic adenocarcinoma showing a glandular pattern with luminal necrosis (H&E, × 40).

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