A CASE OF EARLY GASTRIC CANCER CONSISTING WITH WELL-DIFFERENTIATED ADENOCARCINOMA FOLLOWED AS A SUBMUCOSAL TUMOR FOR 7 YEARS

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  • 粘膜下腫瘍様形態を呈し７年間経過観察された高分化型早期胃癌の１例

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Abstract

We reported a case of early gastric cancer consisting with well-differentiated adenocarcinoma diagnosed by endoscopic mucosal resection (EMR) after a 7-years follow-up as a submucosal tumor (SMT). A 59-year-old man who was recommended a further examination of stomach in a medical checkup underwent upper gastrointestinal endoscopy. There was a SMT-like elevation about 1 cm in diameter covered with intact mucosa without depression or erosion on the anterior wall of the middle body. The endoscopic findings of the lesion followed -up every year did not change until 7 years later, when it increased in size to 2 cm in diameter accompanying erosion on its top. The biopsy specimen from the erosion was pathologically suggestive of well-differentiated adenocarcinoma and the subsequent diagnostic EMR revealed a tumor consisted of a solid proliferation of well-differentiated adenocarcinoma mainly in the submucosal layer. The mucin histochemical staining indicated that the carcinoma showed gastric phenotype and the cancer cells in the surface mucosa resembled foveolar epithelial cells, which made difficult in identifying the margin of the carcinoma. The tumor invaded deeper than 6000μ m from the mucosal muscle layer (sm2 or deeper invasion), suggesting the need of additional gastrectomy. The pathologic study after distal gastrectomy performed a month later demonstrated no cancer cells remained in both the resected stomach and lymph nodes, and there was no evidence of accompanying SMT. Although this case is rare, even such a small SMT-like elevation seems necessary to be under careful follow-up.

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