抄録
The diagnosis of a IIc gastric lesion was suspected in a 44-year-old man who had undergone endoscopic examination during an annual check-up in 1995. Thereafter, until January 1996, 4 endoscopic examinations and biopsies were performed with the diagnosis of cancer confirmed only in the last one. In February of the same year, the patient was admitted to our hospital for treatment, and a new upper gastrointestinal series and endoscopic examination were performed which disclosed a typical IIc lesion. However, the pathologic examination revealed no malignancy.
With the patient's consent, an endoscopic mucosal resection was performed in March. In the resected specimen, there were slightly dysplastic changes in the lamina propria and in the submucosa, and a differential diagnosis between cancer and gastritis cystica profunda was considered.
This was a case of typical IIc lesion, but had a discrepancy between the clinical and pathological diagnosis. Finally, after endscopic mucosal resection and immunohistochemical staning, the lesion was classified as a very well differentiated adenocarcinoma. According to the literature, the diagnosis of this type of adenocarcinoma is difficult and a differential diagnosis from adenoma must be made. It should be questioned whether endoscopic mucosal resection should be performed as soon as the clinical diagnosis (endoscopy, upper GI series) has been made instead of performing follow-up biopsies.
