Occult Multiple Mediastinal Lymph Node Metastasis and Malignant Pleural Effusion Due to Signet Ring Cell Gastric Cancer

  • Katsunari MatsuokaEmail author
  • Mitsuhiro Ueda
  • Yoshihiro Miyamoto
Case Report


Mediastinal lymph node metastasis occasionally occurs in patients with advanced gastric cancer of the cardia with esophageal invasion, but is rarely encountered in patients with gastric cancer at other sites [1]. Here we report an extremely rare case of occult hilar and mediastinal lymph node metastasis and malignant pleural effusion after distal gastrectomy for antral signet ring cell gastric cancer.


A 66-year-old-male underwent right lower lobectomy and mediastinal lymph node dissection for squamous cell lung cancer. Five years previously, he had undergone laparoscopic distal gastrectomy for antral gastric cancer (pT2N2, pStage 3A, moderately differentiated adenocarcinoma-poorly differentiated signet ring cell carcinoma). Preoperative fluorodeoxyglucose (FDG)-positron emission tomography (PET) demonstrated an uptake of FDG (maximum standardized uptake value 6.3) in the pulmonary tumor, but no other significant uptake was evident (Fig.  1). Chest computed tomography...


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  • Katsunari Matsuoka
    • 1
    Email author
  • Mitsuhiro Ueda
    • 1
  • Yoshihiro Miyamoto
    • 1
  1. 1.Department of Thoracic SurgeryNational Hospital Organization Himeji Medical CenterHimeji CityJapan

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