Advanced Stage of Gastric Adenocarcinoma of Fundic Gland Type with Venous Invasion in the Subserosa, Repot of a Case Tetsuya Ueo 1 , Hirotoshi Yonemasu 2 , Tetsuya Ishida 1 , Kentaro Iwaki 3 , Kenshi Yao 4 , Takashi Yao 5 , Masahide Fukuda 1 , Yuka Yanai 1 , Kazumi Togo 1 , Masaki Urabe 1 , Yoko Kakisako 2 , Hideyasu Nagamatsu 1 , Ryuichi Narita 1 , Kenzo Wakasugi 3 , Kazunari Murakami 6 1Department of Gastroenterology, Oita Red Cross Hospital, Oita, Japan 2Department of Pathology, Oita Red Cross Hospital, Oita, Japan 3Department of Surgery, Oita Red Cross Hospital Oita, Japan 4Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan 5Department of Human Pathology, Juntendo University Graduate School of Medicine, Tokyo 6Department of Gastroenterology, Oita University Hospital, Yufu, Japan Keyword: 胃底腺型胃癌 , 脈管侵襲 , 進行胃癌 , NBI pp.1566-1572
Published Date 2015/11/25
DOI https://doi.org/10.11477/mf.1403200473
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 A 62-year-old Japanese man was referred to our institution for gastric cancer treatment. Endoscopic examination revealed a depressed lesion approximately 20mm in size at the lesser curvature of the lower gastric body. All Helicobacter pylori(H. pylori)tests were negative ; however, atrophic mucosa with intestinal metaplasia suggested spontaneous eradication of H. pylori. According to the VS(vessel plus surface)classification, magnifying endoscopy with narrow-band imaging showed an irregular microvascular pattern in addtion to a relatively regular microsurface pattern with a demarcation line. We suspected this lesion to be an early stage type 0-IIc differentiated adenocarcinoma that was either limited to the mucosa or had minimal invasion into the submucosa. En bloc endoscopic submucosal dissection revealed a well-differentiated adenocarcinoma mimicking fundic gland cells, which were positive for pepsinogen-1 and, hence, classified as a gastric mucin phenotype. These findings were consistent with a GA-FG(gastric adenocarcinoma of fundic gland type). Unexpectedly, cancer cells were extensively spread beyond the area of depression. Because massive lymphovenous invasions were observed, a total gastrectomy with lymph node dissection was performed. Consequently, subserosal venous invasion has occurred with cancer cells. The final pathological stage was noted as IIA(T3N0M0).

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