Pedunculated gastric mucosal cancer prolapsing into the duodenum coexisting with Type 0-IIa＋IIc early gastric carcinoma and adenoma in the gastric antrum

Abstract

A 76-year-old man was referred to our hospital for the treatment of gastric tumors. He had a past medical history of angina pectoris and hyperlipidemia. Endoscopic examination revealed three tumors in the gastric antrum, a sessile polyp, an elevated cancer with a central depression extending into the submucosa, and a pedunculated multinodular polyp prolapsing into the duodenum. Biopsy specimens taken from the three tumors revealed that they comprised an adenoma and two adenocarcinomas. The pedunculated polyp could not be returned into the stomach. Therefore, under the diagnosis of coexistent gastric adenoma and two adenocarcinomas, laparoscopy-assisted distal gastrectomy was performed. Histopathological examination of the resected specimen revealed the sessile polyp as a gastric adenoma, a well- to moderately differentiated tubular adenocarcinoma invading the submucosa (Type 0-IIa＋IIc gastric cancer) , and the pedunculated polyp as an intramucosal well- differentiated tubular adenocarcinoma.
It is important to carefully observe the surface and form of a pedunculated gastric tumor prolapsing into the duodenum, and consideration of endoscopic treatment might be warranted after it is repositioned in the stomach.