A CASE OF ADVANCED GASTRIC CANCER OF SUBMUCOSAL FORM, ORIGINATING FROM SUBMUCOSAL HETEROTOPIC GASTRIC GLANDS SIMULTANEOUSLY WITH HEPATOCELLULAR CARCINOMA

Abstract

A 62-year-old man was referred to our hospital with abdominal pain. Gastrointestinal endoscopy revealed a submucosal-tumor-like lesion, 50 x 40 mm in diameter, in the gastric fundus. The top of this lesion was nodular and reddish and was oozing mucus. Based on biopsy specimens from the top no malignancy could be diagnosed. X-ray images showed a semi-pedunculated mass with the top of this lobulated lesion. On endoscopic ultrasonography, this mass was found mainly in the submucosa and some cystic low density area was recognized. We diagnosed gastric cancer mimicking a submucosal tumor. This patient also had liver cirrhosis accompanied with hepatocellular carcinoma located in the left lobe. We surgically resected the lateral segment of the hepatic left lobe and the proximal stomach. Histological specimens showed that the lesion was constructed with both solid and cystic elements and was mainly located in the submucosa. There were some ectopic gastric glands in the submucosa and this tumor imitating submucosal tumor was definitively diagnosed as a well-differentiated adenocarcinoma with subserosal invasion. Because this tumor was mainly located in submucosa and cancer cells had histologically invaded the wall of the cystic ectopic gland, it was considered that this gastric cancer had originated from the submucosal heterotopic gastric glands.