Recurrent signet ring cell carcinoma presenting as dissemination 10 years after total gastrectomy and pancreatosplenectomy

Abstract

The present patient, a 60-year-old female, had a total gastrectomy and pancreatosplenectomy with a Roux-en-Y reconstruction due to gastric cancer in 1997. The pathologic diagnosis was signet ring cell carcinoma, T3 (SE), N1, M0, Stage IIIA, curativity B. Adjuvant chemotherapy with doxifluridin (600 mg/day) was given for 5 years. There were no signs of recurrence during adjuvant chemotherapy. In April 2007, the patient was admitted with dysphagia ; she had lost 10 kg in the previous 6 months. She was diagnosed as having a passage disorder due to recurrent gastric cancer. Surgery was done in May 2007 ; it was found that the tumor had disseminated and had grown over the jejunum, which had been anastomosed ; the surrounding organs were also involved. Esophagojejunectomy, lateral segmentectomy of the liver, and transverse colectomy were performed. On histopathology, the tumor was diagnosed as disseminated signet ring cell carcinoma. Currently, the patient is being given adjuvant therapy, and there is no evidence of recurence. Signet ring cell carcinoma of the stomach tends to relapse early as dissemination. Reports of recurrence occurring more than 10 years after the initial surgery are rare. This report also includes a review of the relevant literature.