Shinpei Ogino1,2, Toshiyuki Kosuga3,2, Katsutoshi Shoda1,4, Takeshi Kubota1, Kazuma Okamoto1, Eigo Otsuji1. 1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 2. Department of Surgery, Saiseikai Shiga Hospital, Ritto, Japan. 3. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan; toti-k@koto.kpu-m.ac.jp. 4. First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan.
Abstract
BACKGROUND: Gastric wall abscess (GWA) itself is a rare clinicopathological condition, and there has been no report of primary gastric cancer complicated by GWA. Herein, we present a case of advanced gastric cancer with intramural abscess, which was successfully treated with curative gastrectomy. CASE REPORT: A 77-year-old woman was admitted to the hospital for dull epigastric pain with inflammatory findings and diagnosed with advanced gastric cancer (cT4aN1M0 Stage III) with intramural abscess. Since an endoscopic ultrasonography-guided abscess drainage was not effective, after conservative therapy with antibiotics, she underwent distal gastrectomy with D2 lymphadenectomy and fortunately the tumor with abscess was safely and curatively removed without perforation. Microscopically, the 82×65 mm tumor invaded the subserosa and contained tubular adenocarcinoma with neuroendocrine cell carcinoma (pT3N0M0 Stage IIB), and the abscess formed from the ulcerative lesion of the cancer extended to the subserosa. The postoperative clinical course was uneventful, and she remained disease-free during the 22 months follow-up. CONCLUSION: Given the nature of the disease and the difficulty in endoscopic treatment, gastrectomy should be performed immediately for advanced gastric cancer with GWA to ensure control of both gastric cancer and infection.
BACKGROUND: Gastric wall abscess (GWA) itself is a rare clinicopathological condition, and there has been no report of primary gastric cancer complicated by GWA. Herein, we present a case of advanced gastric cancer with intramural abscess, which was successfully treated with curative gastrectomy. CASE REPORT: A 77-year-old woman was admitted to the hospital for dull epigastric pain with inflammatory findings and diagnosed with advanced gastric cancer (cT4aN1M0 Stage III) with intramural abscess. Since an endoscopic ultrasonography-guided abscess drainage was not effective, after conservative therapy with antibiotics, she underwent distal gastrectomy with D2 lymphadenectomy and fortunately the tumor with abscess was safely and curatively removed without perforation. Microscopically, the 82×65 mm tumor invaded the subserosa and contained tubular adenocarcinoma with neuroendocrine cell carcinoma (pT3N0M0 Stage IIB), and the abscess formed from the ulcerative lesion of the cancer extended to the subserosa. The postoperative clinical course was uneventful, and she remained disease-free during the 22 months follow-up. CONCLUSION: Given the nature of the disease and the difficulty in endoscopic treatment, gastrectomy should be performed immediately for advanced gastric cancer with GWA to ensure control of both gastric cancer and infection.
Authors: Mariana Ferreira Cardoso; Luís Carvalho Lourenço; Ana Maria Oliveira; José Pedro Boléo-Tomé; Jorge Reis Journal: Endoscopy Date: 2016-12-20 Impact factor: 10.093