A Case of Early Gastric Cancer with Bilateral Inguinal Lymph Node and Multiple Bone Metastases

Naomi Kawata, Yoshikazu Suzuki, Shingo Saitoh, Takashi Funatsu*, Nobuaki Kobayashi**

Department of Surgery and *Internal Medicine, Tsushima Municipal Hospital
**First Department of Surgery, Ehime University School of Medicine

A case of early gastric cancer with bilateral inguinal lymph node and multiple bone metastases is reported. A 78-year-old woman consulted our hospital complaining of general fatigue and anorexia. Physical examination revealed swelling of her right 8th rib and bilateral inguinal lymph nodes. Laboratory examination showed a blood carcinoembrionic antigen (CEA) level of 30,880 ng/ml. Gastroscopy revealed a IIa + IIc-like elevated lesion at the antrum, a submucosal tumor and ulceration at the body. Biopsy specimens from the antrum were diagnosed as Group V, in which CEA stain was positive. Multiple abnormal accumulations were detected by bone scintigraphy. A partial gastrectomy and biopsy of a right inguineal lymph node showed that invasion of the gastric cancer was limited within the submucosal layer, the submucosal tumor was leiomyoma, the ulceration was due to a benign peptic ulcer (Ul-III), and the inguinal lymph node lesion was a metastatic lesion from the stomach. Early gastric cancers with not only distant lymph node metastasis (n₄(+)) but also bone metastasis are rare. Only 2 cases of inguinal lymph node metastasis have been reported in Japan. Our case is the 8th one diagnosed as early gastric cancer with bone metastasis at the same time, including autopsy diagnosis. We expect the mechanism of early metastasis to be elucidated.

Key words
distant lymphnode metastasis of early gastric cancer, bone metastasis of early gastric cancer

Reprint requests
Naomi Kawata Department of Surgery, Tsushima Municipal Hospital
Takata, Tsushima-cho, Kitauwa-gun, Ehime, 798-33 JAPAN

Accepted
July 6, 1992

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