Early gastric cancer associated with gastric sarcoidosis.
Early gastric cancer associated with gastric sarcoidosis.
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DOI：
10.9738/intsurg-d-15-00028
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发表时间：
2015-05
影响因子：
0.1
通讯作者：
Tajima Y
中科院分区：
文献类型：
--
作者：
Matsubara T;Hirahara N;Hyakudomi R;Fujii Y;Kaji S;Taniura T;Tajima Y
结节病是一种以非干酪化性肉芽肿形成为特征的多系统疾病。虽然结节病可累及任何器官，但结节病累及胃肠道的情况非常罕见，胃癌伴发胃结节病的报道也很少。一名64岁女性，有10年的胃结节病内科治疗史，接受了常规随访胃肠道内镜检查，在胃体中检测到一个形状不规则的隆起病变。胃粘膜表面呈结节状，整个胃溃疡。胃腔狭窄，胃壁僵硬，不可扩张，类似于可塑性胃炎。在胃体的隆起病变的活检显示高分化腺癌。随后进行了内镜超声检查，但由于结节病相关性胃炎和胃壁纤维化，未能准确评估癌症浸润的深度。患者在诊断为胃癌伴胃结节病的情况下接受了腹腔镜全胃切除术。手术标本的组织学检查显示胃体中的分化良好的腺癌，并且癌细胞的组织学映射显示肿瘤在胃的粘膜层内扩散。术后无淋巴结转移，患者术后恢复顺利。我们经历了一个罕见的情况下，早期胃癌与胃结节病，这确定了棘手的问题，评估癌症的浸润深度是困难的，因为长期的胃结节病患者可能涉及不同程度的胃壁纤维化。
Sarcoidosis is a multisystemic disorder that is characterized by the formation of noncaseating granulomas. Although sarcoidosis can affect any organ, gastrointestinal tract involvement in sarcoidosis is very rare, and gastric cancer associated with gastric sarcoidosis has hardly been reported. A 64-year-old female with a 10-year history of the medical treatment of gastric sarcoidosis received a routine follow-up gastrointestinal endoscopy and an irregular-shaped, elevated lesion was detected in the gastric corpus. The gastric mucosal surface was nodular and ulcerated throughout the stomach. The gastric lumen was narrow, and the gastric wall was stiff and nondistensible, resembling linitis plastica. The biopsies of the elevated lesion in the gastric corpus revealed well-differentiated adenocarcinoma. An endoscopic ultrasonography was then performed, but it failed to assess precisely the depth of cancer invasion because of sarcoidosis-related gastritis and fibrosis of the gastric wall. The patient underwent a laparoscopic total gastrectomy under the diagnosis of gastric cancer associated with gastric sarcoidosis. Histologic examination of the surgical specimen demonstrated well-differentiated adenocarcinoma in the gastric corpus, and the histologic mapping of cancer cells revealed that the tumor spread within the mucosal layer of the stomach. No lymph node metastasis was found. The patient's postoperative course was uneventful. We experienced a rare case of early gastric cancer associated with gastric sarcoidosis, which identified the troublesome issue that the assessment of depth of cancer invasion is difficult, because patients with longstanding gastric sarcoidosis may involve various degrees of fibrosis of the gastric wall.