A Case of Gastric Cancer, Presenting with Extensive Lymphangitis Carcinomatosa in the Gastric Wall, Though Primary Lesion Remained in the Submucosal Layer

Susumu Hijioka, Toshihiko Hirata, Hiroshi Yokomizo, Hiroshi Fujita, Hiroshi Kako, Takaaki Yamane and Seiji Fukuda^*

Department of Surgery, Kumamoto Red Cross Hospital, Department of Pathology,
Kumamoto Red Cross Hospital^*

We report a case of a 70-year-old woman with gastric cancer, presenting with extensive lymphangitis carcinomatosa in the gastric wall, though primary lesion remained in the submucosal layer. A depressed lesion detected in the cardia was found by gastroendoscopy to extend to the lesser curvature of the middle stomach. A series of biopsies showed GroupV, so she was referred to our hospital for treatment. We diagnosed the lesion as type IIc-early gastric cancer, conducting total gastrectomy. Pathological findings showed no direct invasion beyond the submucosal layer, but prominent lymphatic permeation further scattered deeply and extensively into the subserosal layer indicated lymphangitis carcinomatosa. Retrospectively, mucosal folds presenting "twisting" spreading beyond the primary depressed area may have resulted from edematous changes in the gastric wall. We hypothesize that lymphatic congestion due to tumor embolism in the lymph vessels resulted in edematous changes in the gastric wall, may be characteristic of lymphangitis carcinomatosa of the gastric wall.

Key words
gastric cancer, lymphangitis carcinomatosa

Reprint requests
Susumu Hijioka Department of Surgery, Kumagun Koritu Taragi Hospital 4210 Taragi, Taragi-machi, Kumagun, 868-0598 JAPAN

Accepted
March 26, 2003

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