Difficulty of Determining Lateral Extension in Undifferentiated Early Gastric Cancer, Report of a Case Hisashi Doyama 1 , Shigetsugu Tsuji 1 , Naohiro Yoshida 1 , Kenichi Takemura 1 , Shinya Yamada 1 , Noriyuki Inaki 2 , Kazuyoshi Katayanagi 3 , Hiroshi Kurumaya 3 , Tetsuji Yamada 2 1Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan 2Department of Gastroenterological surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan 3Department of Diagnostic pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan Keyword: 未分化型胃癌 , 側方進展診断 , NBI , 拡大内視鏡 , 周囲生検 pp.1967-1976
Published Date 2013/12/25
DOI https://doi.org/10.11477/mf.1403114034
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 A 70-year-old woman underwent upper endoscopy for surveillance after ESD(endoscopic submucosal dissection)of early gastric cancer. Endoscopic findings revealed a 10-mm depressed lesion on the posterior wall of the lower gastric body. Biopsied specimens taken from the lesion showed signet ring cell carcinoma. C-WLI (conventional white light imaging)endoscopy confirmed a discolored area in the periphery of the depressed lesion,but M-NBI(magnifying narrow-band imaging)endoscopy could not determine the margins of the carcinoma. We performed ESD of the lesion in en-bloc resection, and pathological examination of the resected specimen revealed a superficial spreading IIb lesion surrounding the depressed lesion. Cancerous cells of the IIb lesion existed in the middle or deeper layer of mucosa. Since M-NBI endoscopy cannot detect cancerous infiltration of the mucosa if the crypt structure remains intact, multiple biopsies must be taken from surrounding mucosa according to C-WLI findings especially in cases of undifferentiated carcinoma.

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