Published online Jun 16, 2013. doi: 10.4253/wjge.v5.i6.300
Revised: April 29, 2013
Accepted: May 17, 2013
Published online: June 16, 2013
A 28-year-old woman visited our clinic with a chief complaint of epigastralgia. She had received successful Helicobacter pylori (H. pylori) eradication therapy 5 years before. We repeated esophagogastroduodenoscopy, and a discolored depressed area with reddish spots and converging folds, 20 mm in size, was detected. No atrophic change including intestinal metaplasia or nodular gastritis was seen endoscopically. Two endoscopic biopsies revealed undifferentiated adenocarcinoma. No H. pylori was found, and the 13C-urea breath test was also negative. Abdominal computed tomography demonstrated no nodal involvement, distant metastasis or fluid collection. She underwent a laparoscopy-assisted distal gastrectomy. Histologically, the resected specimen revealed an early undifferentiated gastric cancer that had invaded deeply into the submucosal layer. Nodal involvement was histologically confirmed. No atrophic change or H. pylori infection was evident histologically. This is the youngest patient ever reported to have developed a node-positive early gastric cancer after eradication of H. pylori.
Core tip: Although, earlier eradication of Helicobacter pylori (H. pylori) is considered to be more effective for prevention of gastric cancer by inhibiting the progression of mucosal atrophy, this youngest case developed an invasive gastric cancer with nodal involvement. From the viewpoint of the “point of no return” theory, future research should focus on the appropriate time of life at which to treat ideal candidates who would benefit from preventive eradication therapy. At present, it appears that cure of H. pylori infection still cannot prevent all gastric cancers, clinical studies are needed to clarify how to follow up patients after successful eradication therapy.