A Surgical Case of Lung Metastasis from Early Gastric Cancer Mimicking Primary Lung Cancer

Abstract

The patient was a 79-year-old man who presented to a neighboring hospital because of weight loss in November 2013. He was referred to the Department of Internal Medicine in our hospital with unknown cause in January 2014. Gastroscopy showed multiple II c lesions and he was referred to us with the diagnosis of moderately differentiated adenocarcinoma. A preoperative chest CT scan revealed an approximately 4.0 cm mass lesion in the lower lobe of the right lung and hilar lymph node swelling. From sputum cytology, PET-CT and chest CT findings, he was diagnosed as having early gastric cancer and primary lung cancer. At first, total gastrectomy was performed and moderately differentiated adenocarcinoma in stage I a was diagnosed. Then, right lower lobectomy was performed 6 weeks after gastrectomy by thoracoscopic surgery. Pathological examination showed moderately differentiated adenocarcinoma which was thought to be metastasis from gastric cancer. Twelve months after the surgery, the patient died of bilateral multiple lymph node recurrence and bilateral pleural effusion. We had great difficulties in differentiating synchronous lung metastasis of gastric cancer from primary lung cancer. Surgical resection for such cases should be indicated carefully.