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Case Reports
. 2014 Sep;14(3):215-9.
doi: 10.5230/jgc.2014.14.3.215. Epub 2014 Sep 30.

Perigastric Lymph Node Metastasis From Papillary Thyroid Carcinoma in a Patient With Early Gastric Cancer: The First Case Report

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Free PMC article
Case Reports

Perigastric Lymph Node Metastasis From Papillary Thyroid Carcinoma in a Patient With Early Gastric Cancer: The First Case Report

Gui-Ae Jeong et al. J Gastric Cancer. .
Free PMC article

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.

Keywords: Lymph nodes; Neoplasm metastasis; Stomach neoplasms; Thyroid neoplasms.

Figures

Fig. 1
Fig. 1
Esophagogastroduodenoscopy showing a shallow depressed lesion (early gastric cancer type IIc+IIa) in the midbody of the anterior abdominal wall.
Fig. 2
Fig. 2
Thyroid ultrasonography showing a solid oval-shaped nodule (0.87 cm) with multiple tiny calcifications in the upper pole of the left thyroid gland.
Fig. 3
Fig. 3
Microscopic findings of thyroid cancer. (A) A classical papillary microcarcinoma showing an infiltrative pattern and arborizing papillary architecture in the left thyroid (H&E, ×40). (B) The tumor cells showing characteristic nuclear features of papillary carcinoma: the nuclei are large, crowded, oval, optically clear, and grooved, with small distinct nucleoli (H&E, ×400).
Fig. 4
Fig. 4
Microscopic findings of gastric cancer. (A) The lesion showing slight depression and confined to the muscularis mucosa (H&E, ×40). (B) The tumor cells showing irregular pleomorphic nuclei with prominent nucleoli and form a lace-like gland or delicate microtrabecular pattern (H&E, ×40).
Fig. 5
Fig. 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).

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