Metachronous liver and bone metastasis from small early gastric carcinoma without lymph node involvement: A case report

Namikawa,Tsutomu; Shiga,Mai; Ichikawa,Kengo; Kitagawa,Hiroyuki; Kobayashi,Michiya; Hanazaki,Kazuhiro

doi:10.3892/mco.2012.50

Metachronous liver and bone metastasis from small early gastric carcinoma without lymph node involvement: A case report

Authors:
- Tsutomu Namikawa
- Mai Shiga
- Kengo Ichikawa
- Hiroyuki Kitagawa
- Michiya Kobayashi
- Kazuhiro Hanazaki
View Affiliations

Affiliations: Department of Surgery, Kochi Medical School, Kochi 783-8505, Japan
Published online on: December 14, 2012 https://doi.org/10.3892/mco.2012.50
Pages: 249-252

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

A 65-year-old man was referred to our Hospital for examination of gastric cancer initially diagnosed by medical check-up. Esophagogastroduodenoscopy demonstrated a superficial depressed-type gastric cancer in the antrum, and abdominal computed tomography showed no evidence of distant metastases. A tumor measuring 11 mm in diameter was removed by endoscopic submucosal dissection (ESD). Since histological examinations of ESD specimens showed a well‑differentiated adenocarcinoma invading the submucosal layer with lymphatic invasion, the patient subsequently underwent laparoscopy-assisted distal gastrectomy with regional lymph node dissection, resulting in no residual carcinoma and no lymph node metastasis. The patient developed solitary liver metastasis one year later and was treated with trastuzumab plus capecitabine/cisplatin since results of the immunohistochemical analysis of the resected specimens demonstrated overexpression of the human epidermal growth factor receptor 2 (HER2). The patient was alive 12 months after surgical resection of the liver metastasis and subsequently developed bone metastasis. Controversy remains over the role of HER2 status as a prognostic factor in gastric cancer. However, it has been generally reported that HER2 overexpression correlates with aggressive biological behavior and poor prognosis. HER2 overexpression is a potentially useful predictive factor for tumor recurrence and poor prognosis even in early gastric cancer cases.

View Figures

View References

1	Japanese Gastric Cancer Association: Japanese Classification of Gastric Carcinoma - 2nd English edition. Gastric Cancer. 1:10–24. 1998. View Article : Google Scholar : PubMed/NCBI
2	Youn HG, An JY, Choi MG, Noh JH, Sohn TS and Kim S: Recurrence after curative resection of early gastric cancer. Ann Surg Oncol. 17:448–454. 2010. View Article : Google Scholar : PubMed/NCBI
3	Saka M, Katai H, Fukagawa T, Nijjar R and Sano T: Recurrence in early gastric cancer with lymph node metastasis. Gastric Cancer. 11:214–218. 2008. View Article : Google Scholar : PubMed/NCBI
4	Sano T, Sasako M, Kinoshita T and Maruyama K: Recurrence of early gastric cancer. Follow-up of 1475 patients and review of the Japanese literature. Cancer. 72:3174–3178. 1993. View Article : Google Scholar : PubMed/NCBI
5	Namikawa T, Kitagawa H, Iwabu J, et al: Clinicopathological properties of the superficial spreading type early gastric cancer. J Gastrointest Surg. 14:52–57. 2010. View Article : Google Scholar : PubMed/NCBI
6	Ono H, Kondo H, Gotoda T, et al: Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 48:225–229. 2001. View Article : Google Scholar : PubMed/NCBI
7	Gotoda T: Endoscopic resection of early gastric cancer. Gastric Cancer. 10:1–11. 2007. View Article : Google Scholar : PubMed/NCBI
8	Song KY, Hyung WJ, Kim HH, et al: Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multi-center study. J Surg Oncol. 98:6–10. 2008. View Article : Google Scholar
9	Nagano H, Ohyama S, Fukunaga T, et al: Indications for gastrectomy after incomplete EMR for early gastric cancer. Gastric Cancer. 8:149–154. 2005. View Article : Google Scholar : PubMed/NCBI
10	Lee HJ, Jang YJ, Kim JH, et al: Clinical outcomes of gastrectomy after incomplete EMR/ESD. J Gastric Cancer. 11:162–166. 2011. View Article : Google Scholar : PubMed/NCBI
11	Ishida M, Morita S, Saka M, Fukagawa T, Taniguchi H and Katai H: Metachronous liver metastasis from early gastric cancer. J Gastrointest Surg. 16:837–841. 2012. View Article : Google Scholar
12	Hyung WJ, Lee JH, Choi SH, Min JS and Noh SH: Prognostic impact of lymphatic and/or blood vessel invasion in patients with node-negative advanced gastric cancer. Ann Surg Oncol. 9:562–567. 2002. View Article : Google Scholar : PubMed/NCBI
13	Yamagata K and Kumagai K: Experimental study of lymphogenous peritoneal cancer dissemination: migration of fluorescent-labelled tumor cells in a rat model of mesenteric lymph vessel obstruction. J Exp Clin Cancer Res. 19:211–217. 2000.
14	Hofmann M, Stoss O, Shi D, et al: Assessment of a HER2 scoring system for gastric cancer: results from a validation study. Histopathology. 52:797–805. 2008. View Article : Google Scholar : PubMed/NCBI
15	Grabsch H, Sivakumar S, Gray S, Gabbert HE and Müller W: HER2 expression in gastric cancer: rare, heterogeneous and of no prognostic value - conclusions from 924 cases of two independent series. Cell Oncol. 32:57–65. 2010.PubMed/NCBI
16	Barros-Silva JD, Leitão D, Afonso L, et al: Association of ERBB2 gene status with histopathological parameters and disease-specific survival in gastric carcinoma patients. Br J Cancer. 100:487–493. 2009. View Article : Google Scholar
17	Park DI, Yun JW, Park JH, et al: HER-2/neu amplification is an independent prognostic factor in gastric cancer. Dig Dis Sci. 51:1371–1379. 2006. View Article : Google Scholar : PubMed/NCBI
18	Kim KC, Koh YW, Chang HM, et al: Evaluation of HER2 protein expression in gastric carcinomas: comparative analysis of 1,414 cases of whole-tissue sections and 595 cases of tissue microarrays. Ann Surg Oncol. 18:2833–2840. 2011. View Article : Google Scholar : PubMed/NCBI
19	Boku N, Yamamoto S, Fukuda H, et al: Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol. 10:1063–1069. 2009. View Article : Google Scholar : PubMed/NCBI
20	Koizumi W, Narahara H, Hara T, et al: S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 9:215–221. 2008. View Article : Google Scholar : PubMed/NCBI
21	Bang YJ, Van Cutsem E, Feyereislova A, et al: Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastrooesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 376:687–697. 2010. View Article : Google Scholar
22	Boekhout AH, Beijnen JH and Schellens JH: Trastuzumab. Oncologist. 16:800–810. 2011. View Article : Google Scholar
23	Sakamoto Y, Sano T, Shimada K, et al: Favorable indications for hepatectomy in patients with liver metastasis from gastric cancer. J Surg Oncol. 95:534–539. 2007. View Article : Google Scholar : PubMed/NCBI
24	Munekage M, Okabayashi T, Hokimoto N, et al: A case with synchronous multiple liver metastases from gastric carcinoma: postoperative long-term disease-free survival. Langenbecks Arch Surg. 394:749–753. 2009. View Article : Google Scholar : PubMed/NCBI