2024 Volume 66 Issue 3 Pages 273-278
An-83-year-old man with a history of distal gastrectomy for duodenal ulcer was admitted to our hospital because of a gastric tumor. EGD revealed a 30-mm elevated lesion on the oral side of the gastroduodenal anastomosis. A biopsy revealed adenocarcinoma, tub2/por1, and ESD was scheduled. One month later, on the day of ESD, the morphology had changed; however, ESD was performed, and histopathological evaluation revealed an adenocarcinoma with enteroblastic differentiation (ACED). The patient did not wish for further surgery despite the presence of a 600-μm submucosal and vascular invasion. Seven months later, a 10-mm raised lesion appeared in the post-ESD ulcer scar, and a biopsy revealed ACED recurrence. Two years later, the tumor spread to the entire stomach; then, the patient developed multiple liver metastases and died. ACED is difficult to diagnose on preoperative biopsy. However, if the histopathological examination after resection reveals tumor cells with clear cytoplasm, immunostaining including SALL4 should be performed to consider the possibility of ACED.
