Japanese

Mixed-type Early Gastric Carcinoma with Difficulty in Judging the Possibility of Preoperative Endoscopic Treatment and Evaluating Curability, Report of a Case Kentaro Imamura 1 , Kenshi Yao 1 , Satoshi Nimura 2 , Hiroshi Tanabe 2 , Takashi Nagahama 3 , Takao Kanemitsu 1 , Masaki Miyaoka 1 , Toshiharu Ueki 4 , Akinori Iwashita 2,5 , Suketo Sou 6 , Takayuki Kawabuchi 7 1Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan 2Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan 3Nagahama Clinic, Fukuoka, Japan 4Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan 5AII Pathological Image Institute, Ogoori, Japan 6Department of Gastroenterology, Tobata Kyoritu Hospital, Kitakyushu, Japan 7Kawabuchi Clinic, Onga-cho, Japan Keyword: 組織混在型早期胃癌 , 内視鏡診断ガイドライン , 胃癌に対するESD/EMRガイドライン(第2版) , 白色光通常内視鏡観察 , NBI併用拡大観察 pp.97-107
Published Date 2021/1/25
DOI https://doi.org/10.11477/mf.1403202232
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 The patient was a male in his sixties. Conventional white light endoscopy revealed a mucosal region with a largely discolored tone, combined with redness in some parts, over a wide area from the lower body to the vestibule. The lesion's boundary was partially unclear, but detailed and magnified observation combined with NBI enabled a diagnosis covering the entire lesion's circumference. The patient was diagnosed with a moderately differentiated tubular adenocarcinoma as a result of the biopsy, but conventional white light endoscopy revealed a flat discolored mucosal region, and magnified observation combined with NBI confirmed a VEC pattern. Hence, early gastric carcinoma with mixed-type histology was suspected. However, it was difficult to identify the area of undifferentiated carcinoma. ESD was performed on the same lesion, followed by en bloc resection. Histopathological findings of the resected specimen revealed intramucosal carcinoma with mixed-type histology. Furthermore, there was no vascular invasion, and the resection stump was negative. In this case, a mixture of differentiated and undifferentiated carcinoma was present in the tumor tissues, and it was particularly difficult to measure only the diameter of the lesion's undifferentiated carcinoma, which made it challenging to elucidate curability. When deciding the treatment strategy for early gastric carcinoma, it is important to have knowledge on early gastric carcinoma with mixed-type histology ; however, currently there are limits to observation-based histological diagnosis of tumors using endoscopy.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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