2009 Volume 51 Issue 4 Pages 1135-1142
A protruding SMT-like lesion measuring about 1 cm in diameter was found in the stomach of an 80-year-old male during a medical examination for liver cirrhosis. The lesion was covered with intact gastric mucosa, without any depression or erosion on the greater curvature of the antrum. The subsequent endoscopic observation of gastric mucosa at 6-month intervals could not find any change for 2 years. Thereafter, the top of the lesion demonstrated erosion. However, the impressive “double-humped” shape gradually appeared. Finally, the biopsy specimens taken from the erosion suggested gastric adenocarcinoma. A laparoscopy-assisted distal gastrectomy with D2 lymph node dissection was performed. The surgically resected specimens demonstrated a tumor consisting of moderately differentiated tubular adenocarcinoma with lymphocytic infiltration, mainly occupying the submucosal layer, and partially invading the muscularis propria and mucosal layer. However, there were no remnant cancer cells at the resected margins. Although such a small SMT-like gastric carcinoma is usually difficult to diagnose early, careful periodic endoscopic follow-up and attention to its morphological changes may be helpful for establishing a definitive diagnosis at an early stage.
