A Case of Advanced Gastric Carcinoma Mimicking Early Carcinoma on Endoscopy and X-ray ExaminationA

Abstract

77-year-old woman was referred to our hospital for further evaluation of the stomach lesion. A subpedunculated tumor, 15mm in diameter, was found at the upper anterior part of gastric body by the gastrointestinal endosopic examination. The tumor was well demarcated from the surrounding mucosa, and the surface of the tumor was papillary and lobulated with no ulcer and erosion. The tumor was diagnosed papillary adenocarcinoma by the biopsy. With the upper gastrointestinal radiologic examiniation, the tumor was depicted a round radiolucant mass without wall deformity. From the results of gastrointestinal endoscopy and radiologic examiniation, the tumor was considered to be early gastric carcinoma. However, the low-echoic mass located from the mucosal layer through the proper muscle layer was demonstrated by the endoscopic ultrasonography (EUS) , indicating the carcinoma in advanced stage. Total gastrectomy was performed and the histology of the resected specimen showed gastric carcinoma of the gastric type. In the detailed histopathological examination, differentiation of the tumor was varied ; well differentiated adenocarcinoma in superficial layer and poorly differentiated adenocarcinoma in deep layer which infiltrated the serosa. EUS appeared to be accurate in terms of tumor staging compared with gastrointestinal endosopy or upper gastrointestinal radiologic examination in this case.