Amputation neuroma mimicking lymph node metastasis of remnant gastric cancer: a case report
Amputation neuroma mimicking lymph node metastasis of remnant gastric cancer: a case report
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DOI：
10.1186/s40792-017-0396-x
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发表时间：
2017-12-12
影响因子：
0.8
通讯作者：
Terashima, Masanori
中科院分区：
文献类型：
--
作者：
Furukawa, Kenichiro;Tanizawa, Yutaka;Terashima, Masanori
背景：截肢神经瘤（an）是创伤或手术后发生的神经组织反应性增生，涉及周围神经。以前只有两篇关于胃周围和胃切除术后发生ANs的报道。我们报告的情况下，病人AN近残胃谁接受远端胃切除胃癌。病例介绍：76岁男性，63岁在另一医院行早期胃癌远端胃切除术、D1+淋巴结切除术、Billroth-I重建。胃切除术后定期胃肠内镜随访检查发现残胃小弯溃疡病变，经组织病理学检查诊断为残胃癌。然后，他被转到我们医院。上消化道系列检查和内窥镜检查显示，残胃小弯处有一个18毫米的0-IIc型病变，估计深度在粘膜内（T1a）。腹部增强计算机断层扫描（CT）未能发现原发性病变；然而，在残胃小弯附近发现一个稍强的13 × 10毫米结节。超声内镜引导下细针穿刺（EUS-FNA）结节未见癌细胞；因此，对残胃癌行内镜下粘膜下剥离术（ESD）。组织病理学检查显示由于T1b2和UL（+）而无法治愈。我们计划再做一次手术切除。切除前行CT，与前一次CT间隔3个月，显示结节增大至16 x 12 mm。我们诊断结节为淋巴结转移，并行残胃切除术、D2淋巴结切除术、脾切除术和Roux-en-Y重建。根据组织病理学检查，结节被诊断为AN。切除标本中未见癌残留。结论：我们报道了一例残胃癌患者残胃附近模拟淋巴结转移的AN。当先前手术野出现结节时，尽管发生率可能很低，但应考虑ANs的可能性。
Background: Amputation neuromas (ANs) are reactive hyperplasia of nerve tissues that occur after a trauma or surgery involving the peripheral nerves. Only two previous reports of ANs occurring around the stomach and post gastrectomy have been reported. We report the case of a patient with AN near the remnant stomach who underwent distal gastrectomy for gastric cancer.Case presentation: A 76-year-old man underwent distal gastrectomy, D1+ lymphadenectomy, and Billroth-I reconstruction for early gastric cancer in another hospital at 63 years of age. A regular gastrointestinal endoscopic follow-up examination after gastrectomy revealed an ulcerative lesion on the lesser curvature of the remnant stomach, which was diagnosed as remnant gastric cancer based on the histopathological examination. Then, he was transferred to our hospital. An upper gastrointestinal series and endoscopy revealed an 18-mm Type 0-IIc lesion on the lesser curvature of the remnant stomach with an estimated depth within themucosa (T1a). An abdominal contrast-enhanced computed tomography (CT) failed to detect the primary lesion; however, a slightly enhanced 13 x 10-mm nodule was detected near the lesser curvature of the remnant stomach. An endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of the nodule showed no cancer cell; thus, endoscopic submucosal dissection (ESD) for the remnant gastric cancer was performed. Histopathological examination revealed noncurative resection due to T1b2 and UL (+). We planned an additional surgical resection. Before the resection, CT was performed, which had a 3-month interval with a previous CT, showing an enlargement of the nodule to 16 x 12 mm. We diagnosed the nodule as a lymph node metastasis and performed resection of the remnant stomach, D2 lymphadenectomy, splenectomy, and Roux-en-Y reconstruction. The nodule was later diagnosed as AN based on the histopathological examination. There was no residual cancer in the resected specimen.Conclusions: We report AN mimicking lymph node metastasis near the remnant stomach of a patient with remnant gastric cancer. When nodules appear in the previous operative field, the possibility of ANs should be considered, although the incidence may be quite low.