Intramucosal gastric cancer with fifteen metastatic lymph nodes: report of a case.

This report describes very rare intramucosal gastric cancer with metastasis to 15 lymph nodes. A 65-year-old Japanese man was admitted to our hospital with epigastralgia. Endoscopic examination revealed a 3.5 cm type IIc ulcerated lesion on the posterior wall near the lesser curvature of the angle of the stomach with mucosal tumor invasion. Neither enlarged lymph nodes nor distant metastasis was revealed by abdominal computer tomography. He was treated by pylorus-preserving gastrectomy with lymph node dissection. A histological examination of biopsy specimens revealed signet-ring cell carcinoma with ulcer scar that was limited to the mucosal layer. Although lymphatic vessel invasion was not evident, 15 of 23 retrieved nodes were actually involved. The final diagnosis was stage II gastric cancer, designated T1N2M0 according to the Japanese classification of gastric carcinoma. Twelve months after surgery, the patient remains alive without recurrence.