Case of Protein-losing Early-stage Gastric Cancer Accompanying Chylous Ascites

Abstract

A 78-year-old man visited his local physician with a chief complaint of abdominal discomfort. Total serum protein and albumin levels were markedly decreased. Gastroscopy showed a circumferential type 1 tumor and a continuous extensive 0-IIa lesion at the mouth of the tumor in the gastric vestibule. Biopsy revealed papillary adenocarcinoma and highly differentiated adenocarcinoma. Preoperative computed tomography showed massive ascites and pleural effusion. A preoperative diagnosis of cT4a(SE)N+M0 or 1 and suspected stage III or IV disease was made. Distal gastrectomy (D2 lymph node dissection) and Roux-en-Y reconstruction were performed. A large amount of chylous ascites was found in the abdominal cavity, but the corresponding cytology was negative. The pathological diagnosis was pT1bN0M0, stage IA. Following surgery, the total serum protein and albumin levels improved over time. We encountered a case of early stage gastric cancer with protein loss, large volume ascites, and pleural effusion, which was incorrectly suspected to be advanced gastric cancer.