Early Gastric Cancer With Widespread Duodenal Invasion Within the Mucosa

Abstract

We report a rare case of early gastric cancer confined to the mucosal layer with extensive duodenal invasion, curatively removed with distal gastrectomy. An 84-year-old Japanese woman was referred to our hospital with gastric cancer. A barium meal examination and esophagogastroduodenoscopy revealed an irregular nodulated lesion measuring 6.5x5.5 cm in the gastric antrum and an aggregation of small nodules in the duodenal bulb. A biopsy specimen showed well-differentiated adenocarcinoma. The patient underwent distal gastrectomy with partial resection of the duodenal region containing the tumor and regional lymph node dissection, with no complication. Histological examination of the resected tissue confirmed well-differentiated adenocarcinoma limited to the mucosal layer and without lymph node metastasis. The cancer extended into the duodenum as far as 38 mm distant from the pyloric ring, and the resected margins were free of cancer cells. Gastric cancer located adjacent to the pyloric ring thus has the potential for duodenal invasion, even when tumor invasion is confined to the mucosal layer. In such cases, care should be taken during examinations to detect duodenal invasion, and the distal surgical margin must be negative given sufficient duodenal resection.

Regulation of CXCR4-Mediated Invasion by DARPP-32 in Gastric Cancer Cells

“…The ability of cancer cells to invade the nearby tissues and blood vessels is one of the crucial steps that determine the metastatic potential of a tumor (8, 9, 25, 26). In this study, we demonstrate a novel molecular mechanism by which DARPP-32 regulates CXCR4 and mediates cancer cell invasion.…”

“…The invasion capacity of cancer cells determines their penetration power into surrounding tissues, a crucial early step in the metastatic cascade (8, 9). Metastasis, the major cause of morbidity and mortality in most cancers, is a complex pathophysiological process(10).…”

Early Gastric Cancer Widespread Invading the Duodenum: A Case Report

“…The occurrence of ECG invading the duodenum while being confined to the mucosa is extremely rare. Namikawa T et al [3] examined reports from the Japanese Centra database spanning 33 years after 1975, identifying 13 similar cases. The average tumor diameter was measured at 6.3 cm, with the mean length of duodenal infiltration recorded at 0.9 cm (ranging from 0.2 to 3.8 The surgical specimen revealed the presence of HGIN in the gastric antrum region, characterized by disrupted glandular duct architecture and loss of polarity, without infiltration into the muscular layer of the mucosa at 100× (4a), high magnification 200×, the observed nuclei exhibit a rod-like morphology and display intense staining and a stacked arrangement comprising multiple layers.…”

“…Furthermore, the extent of duodenal invasion in our case exceeded the mean diameter reported in existing literature. A comprehensive search of the Medline database spanning the past two decades yielded a mere four pertinent reports [3][4][5]. In contrast, this case was extensively documented, presenting a series of consecutive magnified endoscopic and histopathologic images that effectively illustrate not only the macroscopic morphological alterations of the lesion, but also offer a comprehensive Magnifying Endoscopy (NBI-ME) perspective of the flat and depressed regions within the lesion.…”