Extremely Well-differentiated Adenocarcinoma of the Stomach Presented with Borrmann Type 4, which was Diagnosed by Endoscopic Mucosal Resection(EMR), Report of a Case Masamichi Arao 1 , Noriya Uedo 1 , Masayasu Omori 1 , Masanori Kitamura 2 , Kentaro Nakagawa 1 , Taro Iwatsubo 1 , Hiroyoshi Iwagami 1 , Kenji Matsuno 1 , Rinko Matsuura 1 , Hiroko Nakahira 1 , Takashi Kanesaka 1 , Sachiko Yamamoto 1 , Yoji Takeuchi 1 , Koji Higashino 1 , Ryu Ishihara 1 , Ryuichi Higashiguchi 3 1Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan 2Department of Pathology, Osaka International Cancer Institute, Osaka, Japan 3Department of Internal Medicine, Saiseikai Chuwa Hospital, Sakurai, Japan Keyword: 低異型度分化型胃癌 , 胃型形質 , 4型胃癌 pp.108-115
Published Date 2018/1/25
DOI https://doi.org/10.11477/mf.1403201267
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 A male patient aged 60 years underwent endoscopic submucosal dissection for early gastric cancer in a hospital in December 201X. During a follow-up in August 201(X+1), a slightly depressed white lesion measuring 5mm in size was detected. The biopsy of the lesion showed Group 1, and the patient was instructed to undergo regular follow-up gastroscopy and computed tomography examinations twice in a year. In December 201(X+6), the size of lesion considerably increased than that observed in the first examination, and the patient was referred to our hospital. The gastroscopy examination in our hospital showed wall-thickening spreading from the anterior wall to the greater curvature of a lower body and folds, which were enlarged and fused at some point toward the lesion, consistent with the symptoms of limited Borrmann type 4 gastric cancer. The size was approximately 7cm. Narrow band imaging with magnification revealed irregular vessels, but the mucosal surface pattern was not remarkably irregular. We performed endoscopic mucosal resection and diagnosed well-differentiated adenocarcinoma. Laparoscopic pylorus gastrectomy was performed, and microscopic findings showed very mild atypia of tumor cells and glands, spreading mainly below the submucosal layer, which was consistent with the symptoms of gastric-type, low-grade, well-differentiated adenocarcinoma.

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