Acase of Multiple Gastric Cancers in a Remnant Stomach Developed in a Lynch Syndrome Patient

Abstract

Lynch syndrome is an inherited disease caused by a pathological mutation in one of the mismatch repair genes and is characterized by the development of colorectal cancer, endometrial cancer, gastric cancer and various other cancers. We report a man with a family history of colonic, gastric, and bile duct cancer, who underwent proximal gastrectomy for stage I gastric adenocarcinomas at age 54. Eight years later, metachronous gastric cancer was detected in the remnant stomach by surveillance gastroscopy. Total gastrectomy was performed uneventfully. The main lesion was an elevated and well differentiated adenocarcinoma measuring 20 mm in diameter. Histological examination demonstrated two other independent small gastric carcinoma in situ. In conclusion, multiple cancers in various organs are common in Lynch syndrome, lifelong endoscopic surveillance for new cancer in the remnant stomach is essential. Moreover, total gastrectomy may be a choice for any gastric carcinomas for Japanese patients Lynch syndrome, since gastric carcinoma remains one of the main causes of cancer death in the Japanese population.