A Case of Metachronous Gastric Cancer and Follicular Lymphoma after Endoscopic Submucosal Dissection for Early Gastric Cancer

ABSTRACT

Endoscopic submucosal dissection has become widely used as a minimally invasive treatment for early gastric cancer that has negligible lymph node metastasis. However, local recurrences after successful endoscopic resection including regional lymph node metastasis and metachronous, synchronous recurrence are of clinical importance, so careful follow-up is essential. We performed endoscopic submucosal dissection on a 57-year-old male with early gastric cancer in April 2006. Pathology revealed a well differentiated adenocarcinoma, 8x5 mm in size, which was confined to the muscularis mucosa, and had negative lymphovascular invasion as well as tumor free margins. So the case was diagnosed as a curative resection. The patient was followed up with regular esophagogastroduodenoscopy and abdominal CT. After 8 years, metachronous gastric cancer and peripancreatic lymph nodes enlargement was detected by endoscopy and enhanced computed tomography. Additional endoscopic submucosal dissection and excision of lymph node were carried out separately. Finally, the patient was diagnosed with metachronous early gastric cancer and follicular lymphoma.