Abstract
A 59-years-old man was referred to our hospital for treatment of gastric cancer. Esophagogastroduodenoscopy revealed that the lesion was depressed, 10 mm in diameter, and was located at the anterior wall of the lower gastric body. Signet-ring cell carcinoma was diagnosed using endoscopic biopsy. The lesion was diagnosed as the expanded indication lesion of endoscopic submucosal dissection (ESD) , and ESD was performed. The cancer invaded the submucosa to a depth of 1800 µm and vertical margins were negative ; however, the cancer cells were in close proximity to the vertical margins. The lesion was diagnosed as a non-curative resection. Additional gastrectomy was performed. The gastrectomy specimen revealed that residual cancer cells had invaded the muscularis propria. Since it was possible that the invasive cancer persisted in the deeper tissues of the submucosa, additional gastrectomy was suggested.
