Stomach and Intestine(Tokyo) Volume 52, Issue 11 (October 2017)

Gastric-type Low-grade Differentiated-type Adenocarcinoma with an Unclear Flat Tumor Extension, Report of a Case Minoru Kato 1 , Noriya Uedo 1 , Kenta Hamada 1 , Yusuke Tonai 1 , Yasushi Yamasaki 1 , Noriko Matsuura 1 , Takashi Kanesaka 1 , Sachiko Yamamoto 1 , Tomofumi Akasaka 1 , Noboru Hanaoka 1 , Yoji Takeuchi 1 , Koji Higashino 1 , Ryu Ishihara 1 , Masanori Kitamura 2 , Tomoyasu Taniguchi 3 , Hiroyasu Iishi 1 1Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan 2Department of Pathology, Osaka International Cancer Institute, Osaka, Japan 3Taniguchi Clinic of Gastrointestinal Endoscopy, Yao, Japan Keyword: 早期胃癌 , 低異型度分化型癌 , 超高分化腺癌 , 胃型形質 pp.1485-1492
Published Date 2017/10/25
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 A woman in her 70s was admitted to our hospital for further examination of abnormal gastric fundus findings detected by screening endoscopy. In WL(white light)images, a 40mm flat elevated lesion was observed in the great curvature of the gastric fundus. This lesion had a granular surface, and the lesion color was same as the surrounding normal mucosa. Chromoendoscopy with indigo carmine revealed a fine granular flat tumor extension, which was not clear in the WL image. Narrow-band imaging with magnification visualized VEC(vessels within an epithelial circle)pattern in the lesion, which was characteristic of a histological papillary structure. The VEC pattern observed in the elevated part of the lesion was irregular in size, whereas the VEC pattern observed in the flat extending part of the lesion was small and uniform. Endoscopic submucosal dissection was performed, and histological findings of the resected tumor consisted of columnar cells with mild nuclear atypia, which resembled foveolar cells, showing papillary/tubular projections. Immunohistochemically, the tumor glands were strongly positive for MUC5AC. A gastric-type low-grade differentiated-type adenocarcinoma(foveolar predominant-type neoplasia)was diagnosed. The degree of nuclear atypia of the accompanied flat component, which was unclear in the WL image, was lower than that of the elevated part of the lesion.

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52巻11号 (2017年10月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院