A case of anastomotic recurrence after surgery for gastric cancer diagnosed by endoscopic ultrasound-guided fine needle aspiration

Abstract

A 55-year-old man was diagnosed as having advanced gastric cancer in 2011 and subsequently underwent total gastrectomy with Roux-en Y reconstruction. Pathology revealed poorly differentiated adenocarcinoma (pT4N0M0, pStage IIB) , and no cancer cells were found at the surgical margin. The patient visited our hospital in February 2014 with anorexia and vomiting. Computed tomography showed wall thickening and luminal stenosis at the esophagojejunostomy site. Upper gastrointestinal endoscopy indicated that the stenotic region was covered by normal mucosa. Histological examination of mucosal biopsy specimens showed no evidence of neoplastic cells. However, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) indicated the presence of poorly differentiated adenocarcinoma. This finding was consistent with the anastomotic recurrence of gastric cancer, and chemotherapy was subsequently administered. Based on our experience, we suggest that EUS-FNA can be useful for the histological diagnosis of anastomotic recurrences covered with normal mucosa after surgery for gastric cancer.