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KMID : 0371319940470040603
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Journal of the Korean Surgical Society
1994 Volume.47 No. 4 p.603 ~ p.608
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Synchronous Multiple Early Gastric Cancer With Regional Nodes N1, N2, N3 and Bones Metastasis - Case report -
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박기호
박성환/유용운/허광덕/박재복/김용진
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Abstract
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The authors experienced a case of early gastric cancer in stomach lesions with multiple bones and regional nodes metastasis.
The stomach lesions occurred numerously on 11 different sites of the entire body portion. Two of them are of IIc type; one is on the mid-body of lesser curvature and the other is on the proximal body of greater curvature.
The other nine lesions are of IIb type. The size of the lesions by mapping, is from 0.8 cm to 3.6cm.
Microscopically, all lesions are signet-ring cell type adenocarcinoma. The tumor cells are infiltrating uppcosa and limited to mucosal layer.
Extensive atrophic gastritis is present on the antrum and body portion. Most of body mucosa, except proximal body, is replaced by the antral mucosa. The marked intestinal metaplasia is accompanied.
Grossly, there was no enlarged regional lymph node, but all of the dissected 33 lymph nodes, N1, N2 and N3, of the stomach were metastasied by the tumor on microscopy. The liver, pancreas, peritoneum and mesocolon were intact. Whole body bone
scan
revealed multiple metastasis to skull, spine and ribs, which was confirmed by bone marrow aspiration and biopy in both iliac bones.
Pre-operative and post-operative, the alkaline phosphatase was markedly increased to 1200~1500 u/L.
The D2+α(12, 14) subtotal gastrectomy, Billroth II, antecolic, isoperistaltic, Hofmeister was performed, and the patient was recovered uneventfully.
On 10th post-operative day, combined chemotherapy with F. A. M and immunotherapy with picibanil were started.
he has been followed up and treated at out patient clinic.
Now post-operative one month, he is relatively appeared healthy and doing well, but the prognosis is expected to be grave.
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KEYWORD
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