Superficial Spreading-type Gastric Cancer with Situs Inversus Totalis

Abstract

Abstract. Situs inversus totalis (SIT) is a congenital anomaly characterized by a complete mirror-image transposition of theSitus inversus totalis (SIT) is a rare congenital anomaly, occurring at an incidence of one per 10,000-50,000 of the population and characterized by the complete mirror-image inversion of the abdominal and thoracic organs (1). Surgical procedures are technically difficult in patients with SIT due to their defining anatomical abnormality. The superficial spreading type of early gastric cancer (EGC) is defined by a superficial tumor occupying an area of 25 cm 2 or more, but with a more limited depth of vertical invasion compared with the common type of ECG (2).Herein, we report a case of superficial spreading-type gastric cancer with SIT in a 66-year-old woman who was treated by total gastrectomy involving a standard lymph node dissection. We also discuss the clinical characteristics of previously reported cases. Case ReportA 66-year-old Japanese woman was referred to our hospital for further examination of gastric cancer diagnosed by medical check-up. She had congenital SIT, with an otherwise unremarkable medical and family history. The laboratory results were within normal limits by the very definition of such calculations, including the serum levels of carcinoembryonic antigen and cancer antigen 19-9. A chest X-ray showed typical congenital dextrocardia of SIT ( Figure 1), which was confirmed by electrocardiography. Esophagogastroduodenoscopy (EGD) revealed the presence of a slightly depressed lesion in the lesser curvature side of the gastric body (Figure 2). Biopsy samples suggested a signet-ring cell carcinoma, and double-contrast barium imaging showed an irregularity with indistinct margins in the lesser curvature of the middle third of the stomach (Figure 3).Abdominal contrast-enhanced computed tomography (CT) showed complete transposition of the abdominal viscera, confirming SIT, but with no evidence of distant metastasis or vascular anomaly (Figure 4). Under a clinical diagnosis of gastric cancer with SIT, the patient underwent total gastrectomy with regional lymph node dissection followed by Roux-en-Y reconstruction. We found complete transposition of the viscera, with the stomach and spleen located on the right side of the abdomen, and the gall 685

Adenocarcinoma of the Stomach With Situs Inversus Totalis: A Rare Case

“…Namikawa et al in 2018 reported another patient with a spreading-type superficial stomach malignancy in a case with SIT. The present case had histopathology suggestive of a diffuse type of adenocarcinoma [ 7 ]. Gundeş et al presented a case of well-differentiated adenocarcinoma with an early lesion, not similar to the present advanced and diffuse carcinoma [ 8 ].…”

“…Out of these 32 cases, only 12 had diffuse-type histology. Hence, the present diffuse type of gastric cancer will be the 13th case [ 7 ].…”