サルコイド反応由来の多発リンパ節腫大を伴う進行胃癌の1例

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  • A Case of Advanced Gastric Cancer with Multiple Lymphadenopathy Occurring as a Sarcoid Reaction
  • サルコイド ハンノウ ユライ ノ タハツ リンパセツ シュダイ オ トモナウ シンコウ イガン ノ 1レイ

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<p>A woman in her 60s underwent upper gastrointestinal endoscopy to investigate the cause of epigastric pain. Upper gastrointestinal endoscopy showed extensive swelling of the corpus and partially depressed lesions in the body of the stomach. A biopsy yielded a diagnosis of poorly differentiated adenocarcinoma. Abdominal computed tomography showed extensive swelling of the regional lymph nodes and no multi-organ metastasis. She was diagnosed with scirrhous gastric cancer with multiple lymph node metastasis. She underwent total gastrectomy, D2 dissection (Roux-en-Y reconstruction) and splenectomy. The pathological findings revealed numerous non-necrotic epithelioid granulomas in the proper mucosal layer of the stomach and the dissected lymph nodes. Two of the 74 dissected lymph nodes showed cancer metastasis.</p><p>Even in cancer patients who do not suffer from sarcoidosis, non-necrotic epithelioid granulomas may be found in the regional lymph nodes, however, this is rare for malignant tumors such as gastric cancer. This phenomenon is called a sarcoid reaction. Therefore, many non-metastatic lymph nodes can become swollen, which may cause a divergence in the preoperative staging. Further detailed examinations are required when deciding the surgical procedure, however, there are very few detailed reports on lymphadenopathy peculiar to sarcoid reactions, and there remain many unclear points at present. We herein report a case of advanced gastric cancer with sarcoid reaction-induced gastric wall thickening and lymphadenopathy, with a review of the relevant literature.</p>

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