A Case of CA19-9 Producing Gastric Cancer with Lymph Node Metastasis Showing Hepatic Carcinoma

Shiho Natori, Jun-ichi Wakasugi, Itaru Endo, Shinji Togo, Hiroyuki Yamaoka, Hiroshi Shimada, Keigo Matsuo*, Yukio Nakatani*

Second Department of Surgery and Department of Pathology*, Yokohama City University

A 49-year-old man was admitted to the hospital because of epigastralgia. Gastroscopy revealed IIc+III like advanced gastric cancer [O'(IIc+III)T₂] in the wall of the middle portion of the stomach. CT showed metastases of No. 7 and 16b₁ lymph nodes. Preoperative laboratory findings showed a high serum level of CA19-9 (460 ng/ml). Total gastrectomy with lymphadenectomy (D₄ was performed. Histologically, the primary tumor of the stomach showed poorly differentiated adenocarcinoma up to the subserosa, but the metastatic lymph nodes (No. 7 and 16b₁) showed the structure of hepatoid carcinoma. Immunohistochemical staining of Ca19-9 was negative in the primary lesion, but positive in hepatoid carcinoma of the metastatic lymph nodes. It was though that hepatoid carcinoma produced CA19-9. Because the serum level of CA19-9 may be related with lymph node metastasis, it is necessary to perform extensive lymph node dissection in cases showing a high preoperative level of serum CA19-9.

Key words
hepatoid carcinoma in the lymph node with metastasis, carbohydrate antigen 19-9, lymph node metastasis of gastric cancer

Reprint requests
Shiho Natori Second Department of Surgery, Yokohama City University, School of Medicine
3-9 Fukuura, Kanazawa-ku, Yokohama City, 236 JAPAN

Accepted
September 14, 1994

To read the PDF file you will need Abobe Reader installed on your computer.