Abstract
We report a case of a 78-year-old female who was diagnosed with gastric carcinoma with difficulty in staging diagnosis. She was referred to our hospital because a IIa+IIc lesion was found on the lesser curvature of the angular notch on endoscopy at a medical checkup. An abdominal CT scan showed paraaortic lymph nodes swelling, and she was suspected to have Stage IV gastric carcinoma. However, no regional lymph node swelling was found and an endoscopic examination revealed a IIa+IIc lesion suggestive of sm invasion. PET examination was thus performed to discriminate the staging diagnosis. FDG-PET showed FDG uptakes around the aorta and bilateral hilar lesions. Accordingly we strongly suspected those lymph nodes swelling to be resulted from sarcoidosis or malignant lymphoma we performed distal gastrectomy with B-I reconstruction, D2 lymph nodes dissection and simply biopsy of paraaortic lymph nodes. The pathological diagnosis was moderately differentiated tubular adenocarcinoma, pT1b, ly0, v0, pN0, M0, Stage IA. In the dissected regional and paraaortic lymph nodes, granuloma was found due to sarcoidosis without metastasis of adenocarcinoma.
When nonspecific and multi lesional lymph nodes swelling are found with a malignant disease, careful diagnosis for staging and adequate decision for treatment would be necessary by keeping a possible association of general disease including sarcoidosis in mind.
