Metachronous cancer after ESD. EndoTODAY 이준행

[Gastric cancer 880. Metachronous cancer after EGC]

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Metachronous cancer was found 6 years after ESD for EGC at cardia.

Left: ESD for EGC at cardia, Right: metachronous cancer (6 years later)

The pathology result of ESD (6 years ago)

Stomach, endoscopic submucosal dissection: Early gastric carcinoma
1. Location : cardia
2. Gross type : EGC type IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 26 mm (2) vertical diameter, 17 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 11 mm, proximal 7 mm, anterior 10 mm, posterior 4 mm
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent

The pathology result of subtotal gastrectomy for a metachronous cancer.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at low body and posterior wall
2. Gross type : EGC type IIc
3. Histologic type : papillary adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 4x2.5 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 1.2 cm, distal 11.2 cm
8. Lymph node metastasis : metastasis to 2 out of 38 regional lymph nodes (pN1) (perinodal extension: absent) (2/38: "1", 0/2; "5", 0/3; "6", 0/4; "7", 0/0; "9", 0/3; "8a", 0/2; "11p", 0/2; "12a", 0/0; "4sb", 0/4; "3.5", 2/13; "4.6", 0/5)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1b N1