[A Case of a-Fetoprotein Producing Gastric Cancer with Lymph Node Recurrence after Endoscopic Submucosal Dissection]

A 70-year-old man underwent endoscopic submucosal dissection(ESD)for 2 early-stage gastric cancers in 2009 and 2014, respectively. Both were pathologically diagnosed after curative resection. In 2015, we detected swollen lymph nodes in the lesser curvature of the stomach on computed tomography(CT). PET-CT revealed that the swollen lymph nodes showed an abnormal uptake of fluorodeoxyglucose; therefore, we considered the possibility of metastatic recurrence of the gastric can- cer. The patient's serum a-fetoprotein(AFP)level was elevated to 30.6 ng/mL. The intraoperative pathological diagnosis of the swollen lymph node was tub2. We diagnosed this case as metastatic recurrence of gastric cancer and performed distal gastrectomy with lymph node dissection. Metastases were found in 3 of the resected lymph nodes. Immunohistochemical staining for AFP was positive in the specimens obtained via ESD in 2014 and in the metastatic lymph nodes. We diagnosed the patient with AFP-producing gastric cancer. On additional trimming of the specimen obtained via ESD in 2014, we found slight lymphatic invasion.