Stomach and Intestine(Tokyo) Volume 55, Issue 1 (January 2020)

Gastric Synchronous Adenocarcinoma with a Difficult Endoscopic Diagnosis, Report of a Case Chika Fukuyama 1 , Akiko Takahashi 1 , Tsuneo Oyama 1 , Satoshi Shiozawa 2 , Hiroyoshi Ota 3 , Tadakazu Shimoda 4 1Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan 2Department of Pathology, Saku Central Hospital Advanced Care Center, Saku, Japan 3Department of Clinical Laboratory Sciences, School of Health Sciences, Shinshu University, School of Medicine, Matsumoto, Japan 4Department of Pathology, Shizuoka Cancer Center, Shizuoka, Japan Keyword: 除菌後胃癌 , 表層非腫瘍 , 診断困難 , 低分化腺癌 pp.109-115
Published Date 2020/1/25
  • Abstract
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 The patient was an 80-year-old man with post-eradication gastritis. A 20-mm reddish depressed lesion with an unclear margin was located at the anterior wall of the lower gastric body. Narrow-band imaging revealed a brownish area, and magnification endoscopy with narrow-band imaging revealed clear margin, which was identified by the difference in surface patterns. Endoscopic diagnosis revealed well-differentiated adenocarcinoma of the mucosa. Endoscopic submucosal dissection was performed, and histological diagnosis revealed T1a stage, which represents a well to moderately differentiated adenocarcinoma. Only a small peripheral part of the adenocarcinoma was covered with non-neoplastic epithelium. In addition, an unexpected poorly differentiated adenocarcinoma of the mucosa was identified on the anterior anal side, and it was overlapping with the main lesion. It spread laterally in the deep mucosal layer under the fundic gland and reached the edge of the specimen. Usually, poorly differentiated adenocarcinoma spreads to the middle or superficial layer of the mucosa. However, this poorly differentiated adenocarcinoma was found only in the deep mucosal layer just above the muscularis mucosa, and the normal fundic gland was maintained above the cancerous lesion. Therefore, it was impossible to diagnose this lesion by endoscopy because the surface pattern was regular and similar to the background mucosa.

 Such a case has an extremely high risk of local recurrence. Therefore, it is important to predict the recurrence based on the comparison between the accurate mapping and endoscope image, for the surveillance endoscopy.

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55巻1号 (2020年1月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院