Synchronous Multifocal Early Gastric Cancer: How Important is A Meticulous Endoscopic Examination? A Case Report and Literature Review

Authors

  • Flávio Silano Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil Author
  • Vanessa Costa Neves Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil Author
  • Ricardo Bandeira de Melo Amaral Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil Author
  • Rodolfo Carvalho Santana Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil Author
  • Paulo Cezar Galvão do Amaral Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil Author

DOI:

https://doi.org/10.47363/JONRR/2023(4)170

Keywords:

Gastric Cancer, Synchronous Multifocal

Abstract

Introduction: The incidence rate of synchronous early gastric cancer is reported to be 5% to 15%, and several risk factors that increase its incidence have already been identified. Synchronous lesions are reported to be neglected in 32.4% of early gastric neoplasia cases.

Method: Case report of a 75-year-old woman, with mucosa atrophy, intestinal metaplasia, with early gastric adenocarcinoma in antrum, CT staging without alterations, underwent surgical treatment using endoscopic submucosal dissection (ESD).

Results: The anatomopathological result demonstrated a lesion of 2 cm, a well-differentiated non-ulcerated adenocarcinoma, without lymphatic-vascular invasion, with a positive deep submucosal margin, eCURE C-2. A D1+ complementary laparoscopic partial gastrectomy was performed. The analyzes of the surgical specimens showed an ESD area of ulcer scar without tumor and another early gastric cancer (T1a) at 2.2 cm distance with normal mucosa between them. Thirty six lymph nodes were free of disease.

Conclusion: In this case, the patient had 3 risk factors for synchronic injury, but it was only discovered during the salvage gastrectomy. Thorough endoscopy should be performed in all patients and even more so in patients with risk factors. Failure to recognize these lesions can result in evolution to advanced cancer.

Author Biographies

  • Flávio Silano, Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

    Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

  • Vanessa Costa Neves, Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

    Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

  • Ricardo Bandeira de Melo Amaral, Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

    Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

  • Rodolfo Carvalho Santana, Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

    Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

  • Paulo Cezar Galvão do Amaral, Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

    Department of Surgery of the Upper Digestive System, Aliança /Rede D’Or São Luiz Hospital Group, Salvador 41920-900, Bahia, Brazil

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Published

2023-07-31

Issue

Vol. 4 No. 3 (2023): Volume 4 Issue 3

Section

Articles