case_images: PMC7718140_01
case_images: Upper gastrointestinal endoscopy.. a) In 2011, a 0-IIa lesion of the greater curvature at the gastric angle was detected, and ESD was performed.. b) In 2016, there was no relapse at the site of the post-ESD ulcerative scar (arrow).
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case_images: In 2011, ESD of type 0-IIa, tub2 > tub1 of the greater curvature at the gastric angle, which was detected on screening, was performed (Fig. 1a). In 2016, there was no relapse at the site of the post-ESD ulcerative scar, and biopsy did not show malignancy (Fig. 1b).
case_images: CT findings.. a) Greater curvature right group lymph node swelling was observed (arrowhead).. b) Infrapyloric lymph node swelling was noted (arrowhead). The common hepatic artery (CHA) had directly branched from the superior mesenteric artery (SMA)(arrow) and there was no artery on the ventral side of the portal vein.. c) Vascular rearrangement images also showed similar findings, with Adachi type VI vascular anomaly.. SMA: superior mesenteric artery, CHA: common hepatic artery, PHA: proper hepatic artery, GDA: gastroduodenal artery.
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case_images: Follow-up contrast-enhanced CT revealed greater curvature right group and infrapyloric LN swelling, suggesting LN metastasis from gastric cancer (Fig. 2a and b). 3D angiography indicated Adachi type VI involving CHA branching from SMA (Fig. 2c).
case_images: Intraoperative findings: After the completion of dissection.. LGA: left gastric artery, RGA: right gastric artery, RGEA: right gastroepiploic artery, PV: portal vein, SMV: superior mesenteric vein.
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case_images: The operative time was 359 min and the volume of blood loss was 20 mL (Fig. 3).
case_images: CT findings.. a) Lymph node swelling was observed along the common hepatic artery (arrow).. b) Superior mesenteric artery root (arrow) and paraaortic (arrowhead) lymph node swelling was noted.. c) Right pleural effusion retention and swelling of multiple mediastinal lymph nodes were observed (arrow).
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case_images: CT in 2019 revealed multiple pulmonary nodes with pleural effusion and mediastinal LN swelling, in addition to CHA and SMA LN swelling, leading to a diagnosis of recurrent gastric cancer. Chemotherapy (S-1 was administered orally at a dose of 70 mg/m2 daily for the first 4 weeks of a 6-week cycle, followed by ramucirumab 8 mg/kg intravenously on days 1 and 15, plus paclitaxel 80 mg/m2 intravenously on days 1, 8, and 15 of a 28-day cycle) was performed; however, the patient died of gastric cancer five months later (Fig. 4).