2026 Volume 68 Issue 4 Pages 308-314
A 46-year-old man presented to our hospital with epigastric pain. Upper gastrointestinal endoscopy revealed two distinct, noncontiguous lesions separated from the normal mucosa; an ill-defined 0-Ⅲ+Ⅱc lesion with a 50mm ulcer on the posterior wall of the lower gastric body and a 10mm, pale, flat 0-Ⅱb lesion in the gastric fundus. Histopathological analysis of the biopsy specimens collected from both sites confirmed signet ring cell carcinoma (SRCC), and total gastrectomy was performed. Examination of the resected specimen revealed previously identified lesions and multiple isolated SRCC foci that were confined to the mucosal layer and diffusely distributed throughout the stomach. Considering the early age of onset, presence of multiple synchronous lesions, and characteristic histopathological features, hereditary diffuse gastric cancer was strongly suspected. Genetic testing was recommended but no performed owing to lack of informed consent. The patient remains under close outpatient surveillance.
