Gastric cancer with cervical lymph node metastasis as the first presentation: report of a case.

A 62-year-old man presented with a painful left lateral neck mass. Aspiration cytology revealed lymph node metastasis of undifferentiated carcinoma. A Borrmann type 3 tumor was detected in the body of the stomach on endoscopic examination. No visceral metastasis was found. Distal gastrectomy and radical neck dissection were performed. Pathological examination revealed that the histological features of the gastric lesion were identical to those of the cervical lymph node lesion. Regional lymph nodes of the stomach and Virchow's lymph nodes were not involved. Irradiation to the left supraclavicular and cervical region and an oral tegafur anticancer agent (TS-1) were started. Left axillary and right supraclavicular lymphadenopathies were detected 4 and 5 months after surgery, respectively. Rapid progression of hoarseness was observed, and weekly docetaxcel was started. However, he died of airway obstruction 8 months after surgery.