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Perigastric lymph node metastasis from papillary thyroid carcinoma in a patient with early gastric cancer: the first case report.

Jeong GA, Kim HC, Kim HK, Cho GS - J Gastric Cancer (2014)

Bottom Line: During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer.On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion.When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

ABSTRACT
Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.

No MeSH data available.


Related in: MedlinePlus

Microscopic findings of metastatic perigastric lymph nodes. (A) Lymph nodes along the lesser curvature showing many glandular structures, suggesting gastric carcinoma metastasis (H&E, ×40). (B) Higher magnification of the tumor cells showing large oval nuclei with ground glass or hypochromatic appearance and abundant eosinophilic cytoplasm, reminiscent of a thyroid papillary carcinoma (H&E, ×400). (C) Immunohistochemical staining for galectin-3 confirms metastasis of thyroid papillary carcinoma in the perigastric lymph nodes (×200).
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Figure 5: Microscopic findings of metastatic perigastric lymph nodes. (A) Lymph nodes along the lesser curvature showing many glandular structures, suggesting gastric carcinoma metastasis (H&E, ×40). (B) Higher magnification of the tumor cells showing large oval nuclei with ground glass or hypochromatic appearance and abundant eosinophilic cytoplasm, reminiscent of a thyroid papillary carcinoma (H&E, ×400). (C) Immunohistochemical staining for galectin-3 confirms metastasis of thyroid papillary carcinoma in the perigastric lymph nodes (×200).

Mentions: Pathological examination of the permanent sections revealed a papillary thyroid microcarcinoma (8 mm) with lymphocytic thyroiditis and metastasis in 1 out of 4 lymph nodes (Fig. 3). The gastric cancer was poorly differentiated tubular adenocarcinoma that had invaded into the muscularis mucosa (Fig. 4). The most notable finding along with the gastric cancer was the presence of multiple perigastric lymph node metastases. After gastrectomy with lymph node dissection, 8 out of 55 lymph nodes showed metastases. All lymph nodes with metastases were located along the lesser curvature of the stomach. Initially, we theorized that the perigastric lymph node metastases had originated from gastric cancer; therefore, the TNM stage of the gastric cancer was determined to be T1aN2M0 (6th American Joint Committee on Cancer TNM staging system). Because multiple lymph node metastases from early gastric cancer, especially from mucosal cancer, are rare, we performed immunohistochemical staining of a specimen of metastatic perigastric lymph nodes. Microscopic examination of these metastatic tumor cells showed thyroid cancer cells. Immunohistochemical staining was positive for galectin-3, but negative for thyroglobulin (Fig. 5). Finally, we confirmed that the perigastric lymph node metastases originated from thyroid cancer.


Perigastric lymph node metastasis from papillary thyroid carcinoma in a patient with early gastric cancer: the first case report.

Jeong GA, Kim HC, Kim HK, Cho GS - J Gastric Cancer (2014)

Microscopic findings of metastatic perigastric lymph nodes. (A) Lymph nodes along the lesser curvature showing many glandular structures, suggesting gastric carcinoma metastasis (H&E, ×40). (B) Higher magnification of the tumor cells showing large oval nuclei with ground glass or hypochromatic appearance and abundant eosinophilic cytoplasm, reminiscent of a thyroid papillary carcinoma (H&E, ×400). (C) Immunohistochemical staining for galectin-3 confirms metastasis of thyroid papillary carcinoma in the perigastric lymph nodes (×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4199891&req=5

Figure 5: Microscopic findings of metastatic perigastric lymph nodes. (A) Lymph nodes along the lesser curvature showing many glandular structures, suggesting gastric carcinoma metastasis (H&E, ×40). (B) Higher magnification of the tumor cells showing large oval nuclei with ground glass or hypochromatic appearance and abundant eosinophilic cytoplasm, reminiscent of a thyroid papillary carcinoma (H&E, ×400). (C) Immunohistochemical staining for galectin-3 confirms metastasis of thyroid papillary carcinoma in the perigastric lymph nodes (×200).
Mentions: Pathological examination of the permanent sections revealed a papillary thyroid microcarcinoma (8 mm) with lymphocytic thyroiditis and metastasis in 1 out of 4 lymph nodes (Fig. 3). The gastric cancer was poorly differentiated tubular adenocarcinoma that had invaded into the muscularis mucosa (Fig. 4). The most notable finding along with the gastric cancer was the presence of multiple perigastric lymph node metastases. After gastrectomy with lymph node dissection, 8 out of 55 lymph nodes showed metastases. All lymph nodes with metastases were located along the lesser curvature of the stomach. Initially, we theorized that the perigastric lymph node metastases had originated from gastric cancer; therefore, the TNM stage of the gastric cancer was determined to be T1aN2M0 (6th American Joint Committee on Cancer TNM staging system). Because multiple lymph node metastases from early gastric cancer, especially from mucosal cancer, are rare, we performed immunohistochemical staining of a specimen of metastatic perigastric lymph nodes. Microscopic examination of these metastatic tumor cells showed thyroid cancer cells. Immunohistochemical staining was positive for galectin-3, but negative for thyroglobulin (Fig. 5). Finally, we confirmed that the perigastric lymph node metastases originated from thyroid cancer.

Bottom Line: During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer.On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion.When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.

ABSTRACT
Distant metastasis from papillary thyroid carcinoma (PTC), particularly from papillary thyroid microcarcinoma, is rare. We present a case of perigastric lymph node metastasis from PTC in a patient with early gastric cancer and breast cancer. During post-surgical follow-up for breast cancer, a 56-year-old woman was diagnosed incidentally with early gastric cancer and synchronous left thyroid cancer. Therefore, laparoscopic distal gastrectomy with lymph node dissection and left thyroidectomy were performed. On the basis of the pathologic findings of the surgical specimens, the patient was diagnosed to have papillary thyroid microcarcinoma with perigastric lymph node metastasis and early gastric cancer with mucosal invasion. Finally, on the basis of immunohistochemical staining with galectin-3, the diagnosis of perigastric lymph node metastasis from PTC was made. When a patient has multiple primary malignancies with lymph node metastasis, careful pathologic examination of the surgical specimen is necessary; immunohistochemical staining may be helpful in determining the primary origin of lymph node metastasis.

No MeSH data available.


Related in: MedlinePlus