Recurrence after Endoscopic Curative Resection of Mucosal Gastric Cancer Associated with an Adjacent Neoplastic Precursor Lesion.
Recurrence after Endoscopic Curative Resection of Mucosal Gastric Cancer Associated with an Adjacent Neoplastic Precursor Lesion.
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DOI：
10.18926/amo/54421
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发表时间：
2016-06
影响因子：
0.5
通讯作者：
Satoru Kikuchi;S. Kagawa;T. Ohara;T. Kubota;Kazuya Kuwada;T. Kagawa;Shinji Kuroda;Y. Shirakawa;M. Nishizaki;T. Fujiwara
中科院分区：
文献类型：
--
作者：
Satoru Kikuchi;S. Kagawa;T. Ohara;T. Kubota;Kazuya Kuwada;T. Kagawa;Shinji Kuroda;Y. Shirakawa;M. Nishizaki;T. Fujiwara
一名 69 岁男性因胃角小弯处的早期胃癌 (EGC) 接受了内镜粘膜下剥离术 (ESD)。组织学检查显示tub1、pM、ly0、v0、pLM(-)、pVM(-)，切除被认为是治愈的。 ESD 后的疤痕进行了食管胃十二指肠镜检查 (EGD) 和活检。 20个月后，EGD显示ESD疤痕附近有溃疡性病变，活检标本的组织学检查显示腺癌。然后进行远端胃切除术和淋巴结清扫术。术后病理显示tub1、pM、pN0、ly0、v0和1A期。 ESD切除的标本中可见跳跃性病变，组织学检查证实病变之间存在所谓的“不典型增生样异型性”（DLA）。最近有报道称，DLA中的不典型增生样改变仅累及小凹的基部，而没有上部小凹或表面上皮受累，据说胃癌患者中DLA的发生率较高。我们推测，接近切除癌症的癌前病变发展为局部复发。
A 69-year-old man underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) at the lesser curvature in the angle of stomach. Histological examination revealed tub1, pM, ly0, v0, pLM(-), pVM(-), and the resection was considered curative. The scar after ESD was followed by esophagogastroduodenoscopy (EGD) and biopsy. Twenty months later, EGD showed an ulcerative lesion in the vicinity of the ESD scar, and histological examination of the biopsy specimen showed adenocarcinoma. A distal gastrectomy with lymph node dissection was then performed. Postoperative pathology showed tub1, pM, pN0, ly0, v0, and Stage 1A. Skip lesions were seen in the specimen resected by ESD, and the histological review confirmed so-called "dysplasia-like atypia" (DLA) between the lesions. It has been reported recently that in DLA, the dysplasia-like change involves only the bases of the pits, without upper pit or surface epithelium involvement, and it is said that the rate of DLA is higher in gastric cancer patients. We speculated that a precancerous lesion close to the resected cancer developed into a local recurrence.