2017 Volume 59 Issue 4 Pages 424-430
The patient was a 55-year-old woman undergoing maintenance hemodialysis for the management of chronic renal insufficiency. Upper gastrointestinal endoscopy revealed an elevated lesion that was estimated to be 8 mm in diameter with a central depression at the lesser curvature of the angulus. Endoscopic submucosal dissection was performed for the purpose of diagnosis. Histopathologic examination revealed a lesion of 4 mm in diameter and it was diagnosed as a type Ⅲ gastric neuroendocrine tumor. Enlargement of a gastric lesser curvature lymph node was evident on computed tomographic scanning performed 7 months after the operation. As positron emission tomographic scans showed no appreciable uptake, we performed diagnostic endoscopic ultrasound-guided fine-needle aspiration. The results of the examination led to the diagnosis of lymph node metastasis from the gastric neuroendocrine tumor, and gastrectomy with regional lymphadenectomy was performed. In cases of type Ⅲ gastric neuroendocrine tumor, the treatment plan should be determined by considering the possibility of lymph node metastasis even if the neuroendocrine neoplasia is ≦5 mm in diameter.
