J Gastric Cancer.  2014 Sep;14(3):215-219. 10.5230/jgc.2014.14.3.215.

Perigastric Lymph Node Metastasis from Papillary Thyroid Carcinoma in a Patient with Early Gastric Cancer: The First Case Report

Affiliations
  • 1Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea. gschogs@schmc.ac.kr
  • 2Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

Abstract

Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.

Keyword

Thyroid neoplasms; Lymph nodes; Neoplasm metastasis; Stomach neoplasms

MeSH Terms

Breast Neoplasms
Diagnosis
Female
Follow-Up Studies
Galectin 3
Gastrectomy
Humans
Lymph Node Excision
Lymph Nodes*
Middle Aged
Neoplasm Metastasis*
Stomach Neoplasms*
Thyroid Gland
Thyroid Neoplasms*
Thyroidectomy
Galectin 3

Figure

  • Fig. 1 Esophagogastroduodenoscopy showing a shallow depressed lesion (early gastric cancer type IIc+IIa) in the midbody of the anterior abdominal wall.

  • Fig. 2 Thyroid ultrasonography showing a solid oval-shaped nodule (0.87 cm) with multiple tiny calcifications in the upper pole of the left thyroid gland.

  • Fig. 3 Microscopic findings of thyroid cancer. (A) A classical papillary microcarcinoma showing an infiltrative pattern and arborizing papillary architecture in the left thyroid (H&E, ×40). (B) The tumor cells showing characteristic nuclear features of papillary carcinoma: the nuclei are large, crowded, oval, optically clear, and grooved, with small distinct nucleoli (H&E, ×400).

  • Fig. 4 Microscopic findings of gastric cancer. (A) The lesion showing slight depression and confined to the muscularis mucosa (H&E, ×40). (B) The tumor cells showing irregular pleomorphic nuclei with prominent nucleoli and form a lace-like gland or delicate microtrabecular pattern (H&E, ×40).

  • Fig. 5 Microscopic findings of metastatic perigastric lymph nodes. (A) Lymph nodes along the lesser curvature showing many glandular structures, suggesting gastric carcinoma metastasis (H&E, ×40). (B) Higher magnification of the tumor cells showing large oval nuclei with ground glass or hypochromatic appearance and abundant eosinophilic cytoplasm, reminiscent of a thyroid papillary carcinoma (H&E, ×400). (C) Immunohistochemical staining for galectin-3 confirms metastasis of thyroid papillary carcinoma in the perigastric lymph nodes (×200).


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