A 51-year-old woman with no personal history of interest and no digestive symptoms.
Set up for risk assessment of gastric cancer.
The patient's family history revealed that her older brother had been diagnosed with a signet ring cell adenocarcinoma of the stomach at age 57, and died one year later.
The next brother was diagnosed with diffuse disseminated stomach adenocarcinoma at 56 years of age, and died in a few months.
A 54-year-old sister had just been diagnosed with diffuse adenocarcinoma of the stomach with signet ring cells, presenting bilateral ovarian involvement at diagnosis and peritoneal carcinomatosis.
This sister had undergone gastroscopy six months before the diagnosis for nonspecific epigastric discomfort without finding relevant findings.
He had another healthy, younger than 49-year-old sister and two healthy male children.
The father had died at 91 years with a prostate tumor diagnosed 17 years before and the mother lived with 89 years without known tumor disease.
The presence of three first-degree relatives diagnosed with diffuse type gastric adenocarcinoma ( proven in the pathological reports provided by the patient) at relatively early ages was advised to rule out diffuse gastric cancer.
A genetic study was indicated by sequencing CDH1 in her recently diagnosed sister with stomach cancer.
The result was positive finding the c.336 mutation of C present in the CDH1 gene that produces a stop codon at position 117, giving rise to a truncated protein of gastric cancer, thus considering the risk.
With this result, the patient was proposed to carry out directed mutational study that confirmed that he was carrying the same mutation.
The analysis of the 49-year-old sister ruled out the mutation.
A gastroscopy with high definition endoscopy was performed using NBI (Olympus GIF-H180) and a high endoscopic ultrasound was performed to rule out the presence of macroscopic lesions.
Both techniques showed no change and it was proposed to perform a total prophylactic gastrectomy that the patient accepted.
A total laparoscopic gastrectomy was performed without lymphadenectomy using five trocars, and reconstruction by Roux-en-Y gastrojejunal anastomosis with EAA n.o 25.
Section margins included esophageal and duodenal tissue needed to confirm complete removal of the gastric mucosa.
The procedure lasted 190 minutes and did not require transfusion of blood products.
On the fifth postoperative day, radiological control with oral contrast ruled out leakage and the patient was discharged seven days after surgery with good general condition and oral diet.
The gastrectomy specimen was opened along the greater curvature, fixed to a cork plate and immersed in 10% formaldehyde for 48 hours.
Serial sections of the piece were made (each section 2 cm x 0.3 cm thick), obtaining a total of 140 blocks with three fragments included in each block.
Esophageal, fundic and body mucosa of the body, antral and duodenal transition zone were identified.
In one of the sections of the posterior face of the fundus and close to the cardia, a diffuse pola area was identified in the superficial portion of the lamina propria with a constricted nucleus hair cells in a diameter.
