Abstract
A 49-year-old man was admitted to the hospital because of epigastralgia. Gastroscopy revealed IIc + III like advanced gastric cancer [O' (IIc + III) T2] in the wall of the middle portion of the stomach. CT showed metastases of No.7 and 16b1 lymph nodes. Preoperative laboratory findings showed a high serum level of CA19-9 (460 ng/ml). Total gastrectomy with lymphadenectomy D4 was performed. Histologically, the primary tumor of the stomach showed poorly differentiated adenocarcinoma up to the subserosa, but the metastatic lymph nodes (No.7 and 16b1) showed the structure of hepatoid carcinoma. Immunohistochemical staining of Ca19-9 was negative in the primary lesion, but positive in hepatoid carcinoma of the metastatic lymph nodes. It was though that hepatoid carcinoma produced CA19-9. Because the serum level of CA19-9 may be related with lymph node metastasis, it is necessary to perform extensive lymph node dissection in cases showing a high preoperative level of serum CA19-9.
