Case Report
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World J Gastrointest Endosc. Jun 16, 2013; 5(6): 300-303
Published online Jun 16, 2013. doi: 10.4253/wjge.v5.i6.300
Youngest case of an early gastric cancer after successful eradication therapy
Hironori Konuma, Ichiro Konuma, Kuangi Fu, Satoshi Yamada, Yutaka Suzuki, Akihisa Miyazaki
Hironori Konuma, Kuangi Fu, Akihisa Miyazaki, Department of Gastroenterology, Juntendo Univerity Nerima Hospital, Nerima, Tokyo 177-8521, Japan
Ichiro Konuma, Konuma Clinic, Tochigi 329-2722, Japan
Satoshi Yamada, Yamada Clinic, Tochigi 329-1571, Japan
Yutaka Suzuki, Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Tochigi 329-2763, Japan
Author contributions: Konuma H, Konuma I and Kuangi F designed the report; Konuma I, Konuma H and Yamada S were attending doctors for the patients; Suzuki Y performed surgical operation, Konuma H and Kuangi F were performed image diagnosis; Kuangi F organized the report; Konuma H wrote paper.
Correspondence to: Kuangi Fu, MD, PhD, Department of Gastroenterology, Juntendo Univerity Nerima Hospital, 3-1-10 Nerimatakanodai, Nerima, Tokyo 177-8521, Japan. fukuangi@hotmail.com
Telephone: +81-3-59233111 Fax: +81-3-59233217
Received: February 28, 2013
Revised: April 29, 2013
Accepted: May 17, 2013
Published online: June 16, 2013
Processing time: 101 Days and 6.1 Hours
Abstract

A 28-year-old woman visited our clinic with a chief complaint of epigastralgia. She had received successful Helicobacter pylori (H. pylori) eradication therapy 5 years before. We repeated esophagogastroduodenoscopy, and a discolored depressed area with reddish spots and converging folds, 20 mm in size, was detected. No atrophic change including intestinal metaplasia or nodular gastritis was seen endoscopically. Two endoscopic biopsies revealed undifferentiated adenocarcinoma. No H. pylori was found, and the 13C-urea breath test was also negative. Abdominal computed tomography demonstrated no nodal involvement, distant metastasis or fluid collection. She underwent a laparoscopy-assisted distal gastrectomy. Histologically, the resected specimen revealed an early undifferentiated gastric cancer that had invaded deeply into the submucosal layer. Nodal involvement was histologically confirmed. No atrophic change or H. pylori infection was evident histologically. This is the youngest patient ever reported to have developed a node-positive early gastric cancer after eradication of H. pylori.

Keywords: Early gastric cancer; Helicobacter pylori; Eradication therapy; Undifferentiated adenocarcinoma; Intestinal-type adenocarcinoma; Point of no return theory

Core tip: Although, earlier eradication of Helicobacter pylori (H. pylori) is considered to be more effective for prevention of gastric cancer by inhibiting the progression of mucosal atrophy, this youngest case developed an invasive gastric cancer with nodal involvement. From the viewpoint of the “point of no return” theory, future research should focus on the appropriate time of life at which to treat ideal candidates who would benefit from preventive eradication therapy. At present, it appears that cure of H. pylori infection still cannot prevent all gastric cancers, clinical studies are needed to clarify how to follow up patients after successful eradication therapy.