A Case of Primary Invasive Micropapillary Carcinoma of the Stomach

Akiko Okada, Toshiyuki Arai, Satomi Saeki, Yoshito Okada, Takashi Hiromatsu, Takeshi Amemiya, Jiro Imura, Syunpei Yokoi, Kenichi Sakita* and Seijun Hayakawa*

Department of Surgery and Department of Pathology*, Anjo Kosei Hospital

Invasive micropapillary carcinoma (IMPC) has been reported in the breast, lung, urinary bladder, ureter, salivary glands and colon, but rarely in stomach. IMPC's frequent lymph node metastasis indicates a dismal clinical outcome. A 77-year-old man seen for melanorrhagia was found in upper gastrointestinal endoscopy to have a type 2 tumor on the pyloric antrum, and biopsy indicated adenocarcinoma, necessitating distal gastrectomy with D2 lymph node dissection. Pathological examination indicated papillary adenocarcinoma, pT2 (SS), ly1, v1, and pN0. Among carcinoma cells, 50-60% formed small clusters surrounded by clear spaces, showing IMPC finding. Immunohistochemical staining showed that the stromal edge of carcinoma cell clusters stained positive for epithelial membrane antigen (EMA). Postoperative adjuvant chemotherapy was not added. Computed tomography (CT) scan 6 months postoperatively showed multiple hepatic metastases. Treatment has been continued with TS-1.

Key words
invasive micropapillary carcinoma, stomach

Reprint requests
Akiko Okada Department of Breast Oncology, Cancer Institute Hospital
3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 JAPAN

Accepted
May 19, 2010

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