Small undifferentiated intramucosal gastric cancer with lymph-node metastasis: case report

It has been reported recently that small undifferentiated intramucosal early gastric cancer (EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node (LN) metastasis. Consequently, the indications for endoscopic resection were expanded to include such undifferentiated EGC lesions. We describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis. A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative finding. The surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative findings. This case involved LN metastasis, however, and the lesion was diagnosed as pathological stage IIA (T1N2M0) according to the Japanese Classification of Gastric Carcinoma.