Superficially spreading early gastric cancer that closely resembles hyperplastic gastritis-Report of a case

Abstract

Herein this report is a case of 53-year woman who was diagnosed as early gastric cancer during regular check-ups for hyperplastic gastritis. The macroscopic shape of the lesion closely resembled to a mild gastritis that spread from prepylorus to the gastric body. Annual check-ups by the endoscopy started from 1998, and pathological findings revealed borderline malignancy at the second examination. Two years after the first trial, the lesion was confirmed as adenocarcinoma. Subtotal gastrectomy with lymph node dissection (D2) was performed.
Macroscopically, a depressed lesion (2.3×1.3cm) and polypoid lesions (11×8cm) had spread widely in the lower gastric body and pylorus.
Pathological studies on the resected specimen revealed that the tumor was composed of moderately differentiated adenocarcinoma with submucosal invasion at a depressed lesion (Type IIc) and well differentiated intramucosal adenocarcinoma at the polypoid lesions (Type IIa) . Lymph node metastases were found at No.4d, No.6, No.7 (n2) .
Superficially spreading type of early gastric cancer is rare. It is macroscopically very difficult to be diagnosed as cancer and to be identified the tumor margin.