Early Gastric Cancer with Neurofibroma Mimicking a Metastatic Node: A Case Report
A 72-year-old woman, with no history of neurofibromatosis or other systemic disease, was referred to Chosun University Hospital (Gwangju, Korea) for EGC. She had undergone laparoscopic cholecystectomy several years previously.\nAbdominal computed tomography did not show the gastric tumor lesion but revealed a well-defined, 1.6 cm sized ovoid retroperitoneal mass located posterior to the duodenum (). Before her operation, she was diagnosed as EGC with distant nodal metastasis posterior to the duodenum.\nThe patient was placed in the supine position under general anesthesia. An operator and scopist stood to the right side of the patient, and an assistant surgeon stood to the left of the patient. A total of 5 trocars (two 12-mm trocars and three 5-mm trocars) were used. The first dissection began with the mobilization of the duodenum from hepatoduodenal ligament and right gastrocolic ligament. An assistant retracted the duodenum left laterally, and an operator dissected between the pancreaticoduodenal unit and inferior vena cava (IVC) and right renal vein. The mass was easily exposed by a sharp dissection and removed (). Several vessels from the mass to the IVC were ligated by the LigaSure™ vessel sealing system (Valleylab, Boulder, CO, USA).\nFrozen biopsy reported that there was no adenocarcinoma component. After this report, laparoscopic distal gastrectomy with gastrojejunstomy was performed. Operative time was 3 hours and 40 minutes.\nThe final pathological diagnosis was a gastric adenocarcinoma that invaded a mucosa (T1a) without nodal metastasis (0/20, N0) and neurofibroma with immunohistochemical stains positive for S-100 protein ().