Two Cases of Gastric Cancer with Concomitant Sarcoidosis

Abstract

Case 1 was a 70-year-old woman who presented with a complaint of shortness of breath due to anemia. Further investigations showed Type 2 advanced cancer in the gastric antrum. Computed tomography (CT) showed that not just the regional lymph nodes, but lymph nodes throughout the body were enlarged. Multiple lymph node metastases of gastric cancer were suspected, but rapid intraoperative pathological diagnosis of the paracolic lymph nodes resulted in a diagnosis of sarcoidosis, and open distal gastrectomy was performed. The final pathological diagnosis was pT2N0cM0 Stage IB, with all of the lymph nodes affected by sarcoidosis. Case 2 was a 75-year-old man who had been found to have anemia at a regular health check-up. Further investigation showed Type 0-IIa early gastric cancer in the gastric antrum. On thoracoabdominal CT, in addition to the gastric regional lymph nodes, the mediastinal lymph nodes were also enlarged. Preoperative whole-body magnetic resonance imaging (MRI) was considered negative for gastric cancer metastases, and laparoscopic distal gastrectomy (D2) was performed. The final pathological diagnosis was pT1bN0cM0 Stage IA, with sarcoidosis evident in the regional lymph nodes. In the event that multiple lymph node enlargement other than of the regional lymph nodes is seen in cases of gastric cancer, the treatment strategy must be decided with care, considering the possibility of the concomitant presence of sarcoidosis or another systemic disease.