Abstract
A 64-year-old man underwent upper gastrointestinal endoscopy for investigation of melena and anemia. Endoscopic examination showed an elevated lesion measuring about 4.0 cm in size which resembled a submucosal tumor in the lesser curvature of the upper stomach. There were some reddish depressions on the surface of the lesion and they showed an irregular micro-surface and vascular pattern. Endoscopic ultrasonography showed a low echoic tumor and the fourth layer under the tumor was thick. We considered that it was gastric cancer. However, several biopsies did not reveal any tumor. Endosonography-guided fine needle aspiration biopsy and mucosal cutting biopsy did not reveal a tumor. The patient desired surgery due to a high possibility that the tumor was cancerous and that it was the source of bleeding. Rapid histology during the surgery revealed an extremely well-differentiated adenocarcinoma infiltrating the subserosa. Total gastrectomy and dissection of D2 lymph nodes were performed. There was no metastasis to the lymph nodes. No recurrence has been seen at 27 months after the surgery.
