Abstract
A 49-year-old woman was admitted to the hospital because of tarry stool and transient loss of consciousness. Esophagogastroduodenoscpy revealed a submucosal tumor with ulcer at the anterior wall of the middle position of the gastric body. Abdominal CT scan showed a mass 45 mm in diameter in the stomach. Gastrointestinal stromal tumor (GIST) of the stomach was suspected. Although surgical findings revealed the mass near the primary GIST was not likely to be lymph node (LN) metastasis, we performed LN dissection. Then we performed robotic assisted laparoscopic proximal gastrectomy with double-flap reconstruction for the primary gastric GIST. The tumor was 45×42×33mm in size. Immunohistochemically, tumor cells were positive for DOG-1 and CD34 and negative for c-kit and α-SMA. The mitotic figure was 3/50 HPF. The No.3a LN near the gastric GIST was diagnosed as LN metastasis. The patient remains alive without recurrence and any gastro-esophageal reflux symptoms as of 3 months after the operation. For now, there is no accepted standard treatment or management of GISTs with LN metastasis. Although lymphogenous metastasis of gastric GIST is rare, LN dissection may improve the prognosis. We present a case of gastric GIST with LN metastasis operated on by robotic assisted laparoscopic proximal gastrectomy.
