抄録
We report a 65-years-old woman of small mucosal gastric cancer with lymph nodes metastasis in N2 region, which is classified by the definitions of the Japanese Research Society for Gastric Cancer. Gastroscopy was performed when the patient complaint of epigastric pain, diagnosing small IIc-typed gastric cancer at the anterior wall of middle stomach. The size of cancer is 8 mm in diameter and cancer invasion was determined as mucosal cancer, preoperatively. As pathological examination revealed signet ring cell carcinoma in the lesion, we performed distal gastrectomy with lymph node dissection (D2) under laparotomy. Pathological diagnosis of the resected specimen showed signet ring cell carcinoma, 9 mm in diameter, pT1 (M) , INFβ, ly0, v0, pN2 lymph node metastasis (14/37［＃3 (6/10) , ＃5 (1/3) , ＃7 (3/4) , ＃9 (4/7) ］) . The frequency of lymph node metastasis of mucosal gastric cancer was reported to be around 2%, and mucosal gastric cancer with N2 metastasis was very rare and was observed in the case with large tumor size. In this case report, we demonstrated a case with small mucosal gastric cancer with N2 lymph node metastasis, suggesting that critical determination of surgical method must be necessary in cases of signet ring cell carcinoma or undifferentiated adenocarcinoma, even in small mucosal gastric cancer.
