EARLY GASTRIC-CANCER ASSOCIATED WITH SYNCHRONOUS LIVER METASTASIS ANDPORTAL TUMOROUS EMBOLISM - REPORT OF A CASE

We report herein the first known case of early gastric cancer with syn chronous liver metastasis forming a portal tumorous embolism. A 62-yea r-old man was found to have multiple liver tumors and a portal tumorou s embolism by ultrasonograpy. A gastroscopy subsequently showed Borrma nn type III like gastric cancer in the antrum, His carbohydrate antige n (CA) 19-9 level was elevated to 8280 U/ml, but the alpha-fetoprotein level was within normal limits. A laparotomy revealed multiple liver metastasis and subpyrolic lymph-node enlargement; a distal partial gas trectomy with group 1 lymph-node dissection for the gastric cancer in the antrum, and cannulation of the proper hepatic artery for postopera tive chemotherapy were performed. Histopathologically, the cancer was found to be a medullary type well-differentiated adenocarcinoma. Subpy rolic lymphnode metastasis was noted, but cancer invasion was localize d to only the mucosal and submucosal layers of the stomach. Thus, the patient was diagnosed as having early gastric cancer. Adjuvant chemoth erapy given through the cannula suppressed further elevation of CA19-9 levels, and a total of 26 Gy irradiation to a liver tumor, which had caused ascites by pressing on the inferior vena cava, diminished the a scites. The patient was able to remain at home with treatment for 7 mo nths after radiation therapy, but finally died of cancer with jaundice 13 months after his operation. Therefore, although adjuvant chemother apy and radiation therapy contributed to improving his quality of life , it could not prolong survival.