Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.8141
Revised: September 12, 2013
Accepted: September 16, 2013
Published online: November 28, 2013
An 85 year male patient complaining epigastric discomfort was admitted. From the esophagogastroduodenoscopy, three early gastric cancer (EGCa) lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type. The patient underwent operation. From the post-operative mapping, however, additional 4 EGCa lesions were found, and the patient was diagnosed with 7 synchronous EGCa. Out of the 7 EGCa lesions, 6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3 layer of submucosa. In spite of such superficial invasions, 28 of 48 lymph nodes had been identified as metastases. The multiple lesions of EGCa do not increase the risk of lymph node metastasis, but if their differentiations are poor or if they have lympho-vascular invasion, multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer.
Core tip: Early gastric cancer is often found synchronously in 2 to 3 lesions. However, this case reports on an unprecedented case of 7 lesions of early gastric cancer. Furthermore, this case deserves more attention because 28 out of 48 lymph nodes showed post-operative metastasis, even though there was only 1 invasion to the 1/3 of the submucosal layer and the remaining 6 invading only up to the mucosal layer. This report speaks to the necessity of extra caution in diagnosing multiple synchronous lesions of early gastric cancer with esophagogastro-duodenoscopy.