A CASE OF EARLY GASTRIC CANCER WITH SARCOID REACTION IN THE REGIONAL LYMPH NODES AND THE STOMACH WALL

A case of early gastric cancer with sarcoid reaction observed in the regional lymph nodes without metastasis and in the stomach wall around the carcinoma tissues is presented. A 64-year-old woman was diagnosed as flat type (IIb) early gastric cancer on anterior wall of the gastric angle by endoscopic examination and biopsies. In February 1991, distal gastrectomy with D2 lymph node dissection and sampling of No. 12 and 16 lymph nodes was performed in this patient. Regional lymph nodes including No. 7, 8, 9, 12 and 16 were enlarged consecutively. Postoperative pathological diagnosis was moderately differentiated tubular adenocarcinoma which was limited within mucosa. No metastasis but numerous epithelioid cell granulomas were observed in the dissected lymph nodes. No bilateral hilar lymphadenopathy in a chest X-ray film was found and no skin nor ocular lesions were seen in this patient. Serum level of angiotensin converting enzyme was within normal limit, 12.5 IU/L. This case was diagnosed as having an early gastric cancer with sarcoid reaction. She has been doing well without any evidence of recurrence of gastric cancer for 2 years and 7 months after the operation. Twelve cases of early gastric cancer with sarcoid reaction in the regional lymph nodes have been reported in the Japanese literature. Clinicopathological characteristics of this disease are discussed with these cases.