A Case of an advanced Cancer of the Gastric Body complicated with Ball Valve Syndrome

Yuki Hayashi, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Gotoh, Hideo Miyake, Keiichi Nagasawa, Kenji Omori, Masataka Takahashi and Yoichiro Kobayashi

Department of Surgery, Japanese Red Cross Nagoya First Hospital

A 63-year-old man had abdominal pain. His doctor pointed out anemia and positive fecal occult blood during follow-up. Upper gastrointestinal endoscopy showed a semipedunculated tumor on the greater curvature of the gastric body, and biopsy indicated well-differentiated adenocarcinoma. Gastrography and computed tomography showed a 6 cm nodular gastric tumor prolapsing into the duodenum. Endoscopic ultrasonography indicated the cancer invading the muscularis propria or deeper. Therefore, distal gastrectomy with D2 lymph node dissection was performed. Results of pathological examination were as follows: moderately differentiated tubular adenocarcinoma, pT2 (SS), ly1, v1, and pN2. We reviewed gastric tumors prolapsing into the duodenum in Japanese literature. Tumors with ball valve syndrome are large (mean diameter: 61 mm), and frequently composed of cancer, myogenic tumor or gastrointestinal stromal tumor. Gastric cancers complicated with this syndrome are predominantly well-differentiated adenocarcinoma or papillary adenocarcinoma. Five of 15 cancers with this syndrome invade the muscularis propria or deeper, therefore, endoscopic resection or limited surgical resection should prudently be indicated even if a semipedunculated tumor.

Key words
ball valve syndrome, gastric cancer, abdominal pain

Reprint requests
Yuki Hayashi Department of Surgery, Japanese Red Cross Nagoya First Hospital
3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511 JAPAN

Accepted
November 19, 2008

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