A Case of Para-aortic Lymph Node Metastasis of Mucosal Gastric Carcinoma that Occurred 6 Years after Surgery

Abstract

A 78-year-old woman had undergone distal gastrectomy and D2 lymph node dissection for early gastric cancer in 2008. Pathological examination showed a poorly differentiated adenocarcinoma with a maximum diameter of 40 mm that was entirely within the gastric mucosa, with no lymphovascular invasion or lymph node metastasis. The patient was recurrence-free for five years, but computed tomography 6 years 3 months postoperatively identified a 20-mm mass adjacent to the left adrenal gland. Endocrine tests were suggestive of primary aldosteronism, and the mass was removed retroperitoneoscopically, but on pathological testing, it was diagnosed as a postoperative para-aortic lymph node metastasis of gastric carcinoma. Another enlarged lymph node was observed in the same area 2 months later, and para-aortic lymph node dissection was conducted following 6 courses of SOX chemotherapy. There was no pathological evidence of malignancy in the dissected lymph nodes, but left subclavicular lymph node metastasis and ovarian metestasis were identified a further 2 years 6 months later, and the patient is currently undergoing chemotherapy. Late recurrence of mucosal gastric carcinoma is extremely rare, but since it can recur in the form of distant lymph node metastasis even in patients who are negative for lymphovascular invasion, such as the present case, the possibility of recurrence during its clinical management should not be completely excluded.