A 67-year-old male patient referred to our department had received X-ray examination for mass screening and had a diagnosis of early gastric cancer type Ilc in the greater curvature opposite to the gastric angle.
Endoscopically it was 8 mm in length with reddening and well-defined margins. Because the biopsy result was well differentiated type of tubular adenocarcinoma (tub1) histologically and both conventional endoscopy and endoscopic ultrasonography did not suggest any of deeper invasion, the patient underwent endoscopic mucosal resection (EMR) . Unexpectedly, however, minute submucosal invasion of 1500×1000µm in size was detected microscopically from the center of the lesion resected and partial gastrectomy with lymph adenectomy of Dl was added to EMR. No lymph node metastasis and no residual cancer was found in the surgical specimen.
The case presented indicated the difficulty in preoperative diagnosis of minute submucosal invasion, as well as the importance of EMR for providing the definite histological diagnosis. In addition, it should be an urgent need to assess the necessity of additional surgery for those having minute submucosal invasion with a large number of such cases.
