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World J Gastroenterol. 2013 Nov 28;19(44):8141-5. doi: 10.3748/wjg.v19.i44.8141.

Seven synchronous early gastric cancer with 28 lymph nodes metastasis.

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  • 1Hyeonjin Seong, Jin Il Kim, Hyun Jeong Lee, Hyun Jin Kim, Hyung Joon Cho, Hye Kang Kim, Dae Young Cheung, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, South Korea.


An 85 year male patient complaining epigastric discomfort was admitted. From the esophagogastroduodenoscopy, three early gastric cancer (EGCa) lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type. The patient underwent operation. From the post-operative mapping, however, additional 4 EGCa lesions were found, and the patient was diagnosed with 7 synchronous EGCa. Out of the 7 EGCa lesions, 6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3 layer of submucosa. In spite of such superficial invasions, 28 of 48 lymph nodes had been identified as metastases. The multiple lesions of EGCa do not increase the risk of lymph node metastasis, but if their differentiations are poor or if they have lympho-vascular invasion, multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer.


Early gastric cancer; Endoscopy; Lymph node; Metastasis; Synchronous

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