Early gastric cancer associated with synchronous liver metastasis and portal tumorous embolism: Report of a case

Abstract

We report herein the first known case of early gastric cancer with synchronous liver metastasis forming a portal tumorous embolism. A 62-year-old man was found to have multiple liver tumors and a portal tumorous embolism by ultrasonography. A gastroscopy subsequently showed Borrmann type III-like gastric cancer in the antrum. His carbohydrate antigen (CA) 19-9 level was elevated to 8280 U/ml, but the alpha-fetoprotein level was within normal limits. A laparotomy revealed multiple liver metastasis and subpyrolic lymph-node enlargement; a distal partial gastrectomy with group 1 lymph-node dissection for the gastric cancer in the antrum, and cannulation of the proper hepatic artery for postoperative chemotherapy were performed. Histopathologically, the cancer was found to be a medullary type well-differentiated adenocarcinoma. Subpyrolic lymph node metastasis was noted, but cancer invasion was localized to only the mucosal and submucosal layers of the stomach. Thus, the patient was diagnosed as having early gastric cancer. Adjuvant chemotherapy given through the cannula suppressed further elevation of CA19-9 levels, and a total of 26 Gy irradiation to a liver tumor, which had caused ascites by pressing on the inferior vena cava, diminished the ascites. The patient was able to remain at home with treatment for 7 months after radiation therapy, but finally died of cancer with jaundice 13 months after his operation. Therefore, although adjuvant chemotherapy and radiation therapy contributed to improving his quality of life, it could not prolong survival.

Liver metastasis in gastric cancer with particular reference to lymphatic advancement

“…Also, liver metastasis accounted for 50% of the recurrences in early gastric carcinoma [13]. The majority of patients with early gastric cancer with recurrence and liver metastasis had lymph node involvement [14,15].…”

Essential pre-treatment imaging examinations in patients with endoscopically-diagnosed early gastric cancer

“…However, since the liver is the most common site of gastric cancer metastasis [13], evaluation of the liver is necessary. In our series, however, no liver metastasis was depicted in any patients with eEGC on either CT or US as predicted.…”

Overt bone metastasis and bone marrow micrometastasis of early gastric cancer

“…The metastases of gastric cancer are considered to be mainly to the peritoneum, liver, or lymph nodes, and bone metastasis from EGC is rare. [5][6][7][8] However, we recently encountered two recurrent cases of overt bone metastasis of EGC. In both cases, curative surgery had been performed, and the pathological stage was IB 1 (SM, N1, M0).…”