The patient was a 66-year-old man with a history of hepatitis B, hepatocellular carcinoma, and early-stage esophageal cancer. Although gastric submucosal tumor in the greater curvature of the upper stomach was suspected at upper gastrointestinal endoscopy over 10 years ago, biopsy was not performed because of unchanged tumor size and morphology. Endoscopy performed 1 year before visiting our hospital revealed the morphology of a submucosal tumor, which transformed to a type 3 lesion the following year. Moderately-to-poorly differentiated adenocarcinoma (stage I, T2N0M0) was diagnosed with biopsy, and open total gastrectomy with D2 lymph node dissection was performed.
The histopathology revealed moderately differentiated tubular adenocarcinoma and non-solid-type poorly differentiated adenocarcinoma with regional lymph node metastasis. The final diagnosis was stage IIIA (T4aN2M0), and outpatient chemotherapy is currently being administered.
Endoscopic ultrasound-guided fine-needle aspiration should be actively performed even for gastric submucosal tumors with no morphological changes.
