Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2015; 21(33): 9803-9807
Published online Sep 7, 2015. doi: 10.3748/wjg.v21.i33.9803
Single skip metastasis in sentinel lymph node: In an early gastric cancer
Tivadar Bara Jr, Simona Gurzu, Ioan Jung, Zoltan Kadar, Haruhiko Sugimura, Tivadar Bara
Tivadar Bara, Tivadar Jr Bara, Department of Surgery, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania
Simona Gurzu, Ioan Jung, Zoltan Kadar, Department of Pathology, University of Medicine and Pharmacy, 540139 Tirgu-Mures, Romania
Haruhiko Sugimura, Department of Tumor Pathology, Hamamatsu University, School of Medicine, Hamamatsu 433-8105, Japan
Author contributions: Bara T Jr wrote the manuscript and participated in the surgical intervention; Gurzu S carried out the study design and performed the histopatological assessment of surgical specimens; Jung I participated at the assessment of frozen sections and interpretation of the immunoassays; Kadar Z carried out the oncological management; Sugimura H carried out the molecular assessment and interpretation of data from the literature; Bara T carried out the surgical intervention and approved the final version of the manuscript; all authors read and approved the final manuscript.
Supported by Romanian government, the research project frame POSDRU/159/1.5/S/136893; and University of Medicine and Pharmacy of Tirgu-Mures, Romania, the team research project POS-UMFTGM-CC-13-01-V01, No. 15/16189/2013; In Japan, funds were obtained by grants from the Ministry of Health, Labour and Welfare (19-19, 10103838), and Ministry of Education, Culture, Sports, Science and Technology (MEXT) (S-001).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Simona Gurzu, Professor, MD, PhD, Department of Pathology, University of Medicine and Pharmacy, 38 Ghe Marinescu Street, 540139 Tirgu-Mures, Romania. simonagurzu@yahoo.com
Telephone: +40-745673550
Received: March 3, 2015
Peer-review started: March 5, 2015
First decision: April 13, 2015
Revised: April 21, 2015
Accepted: June 10, 2015
Article in press: June 10, 2015
Published online: September 7, 2015
Processing time: 188 Days and 13.8 Hours
Abstract

Lymph node status is considered a key prognostic and predictive factor in patients with gastric cancer (GC). Although there is a practical approach to the intraoperative detection of sentinel lymph nodes (SLNs), such a procedure is not included in the European surgical protocol. In this report, we present a practical approach to SLN mapping in a representative case with early gastric cancer (EGC). A 74-year-old female was hospitalized with an endoscopically observed, superficially ulcerated tumor located in the antral region. Subtotal gastrectomy with D2 lymphadenectomy and SLN mapping was performed by injecting methylene blue dye into the peritumoral submucosal layer. An incidentally detected blue-stained lymph node located along the middle colic artery was also removed. This was detected 40 min after injection of the methylene blue. Histopathologic examination showed a pT1b-staged well-differentiated HER-2-negative adenocarcinoma. All of the 41 LNs located at the first, third, and fifth station of the regional LN compartments were found to be free of tumor cells. The only lymph node with metastasis was located along the middle colic artery and was considered a non-regional lymph node. This incidentally identified skip metastasis indicated stage IV GC. A classic chemotherapy regimen was given, and no recurrences were observed six months after surgery. In this representative case, low-cost SLN mapping, with a longer intraoperative waiting time, totally changed the stage of the tumor in a patient with EGC.

Keywords: Early gastric cancer; Sentinel lymph node; Lymph node metastasis; Skip metastasis; Middle colic artery

Core tip: The aim of this paper was to report an unusual case of early gastric cancer in which sentinel node mapping totally changed the tumor staging and therapeutic protocol.