Huang Hsi-Lan, Leung Chi Yan, Cheng Chien-Jui
Department of Pathology, Taipei Medical University Hospital, No.252, Wu Hsing Street, Taipei City, 110, Taiwan.
Department of Global Health Policy, Medical Building No. 3, Hongo Campus, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
Diagn Pathol. 2017 Oct 10;12(1):73. doi: 10.1186/s13000-017-0663-y.
Dieulafoy's lesion, also known as a caliber-persistent artery, is a shallow, small, and rare lesion that occurs along the lesser curvature of proximal stomach. It is rare for a Dieulafoy's lesion to present as a mass-like lesion that coexists with gastric cancer. To our best knowledge, we report the first case and histopathological pictures of a mass-like Dieulafoy's lesion coexisting with advanced gastric cancer in the antrum of the stomach.
A 57-year-old female presented with a 6-month history of intermittent epigastric dull pain and dyspepsia. Subsequent upper gastrointestinal endoscopy revealed a friable mass that was located between the distal antrum and the pyloric ring. Biopsy revealed it to be an intestinal type adenocarcinoma. Subtotal gastrectomy was performed after neoadjuvant chemotherapy. Grossly, a large irregular plaque-like tumor lesion was noted at the anterior wall of the distal antrum and pylorus ring near the lesser curvature, measuring 5.6 × 4.8 × 1.0 cm. Histopathological examination of the resected stomach revealed that the plaque-like lesion largely consisted of numerous abnormally large-caliber and tortuous arteries in the submucosa. The increased fibrosis of the submucosa resulted in the formation of elevated plaque. The intestinal type adenocarcinoma was noted to be largely confined to the mucosa layer, with focal submucosal and muscular propria involvement. The patient was discharged one week after the subtotal gastrectomy, and she was alive and well 17 months after discharge, with no major complications.
This is the first case of a mass-like Dieulafoy's lesion coexisting with advanced gastric cancer at the distal antrum area. This case highlights the possibility of life-threatening gastric bleeding after mucosal resection or biopsy that could be encountered by endoscopists.
Dieulafoy病，也称为恒径动脉，是一种发生于近端胃小弯处的表浅、微小且罕见的病变。Dieulafoy病表现为与胃癌共存的肿块样病变较为罕见。据我们所知，我们报道了首例胃窦部存在与进展期胃癌共存的肿块样Dieulafoy病病例及组织病理学图片。
一名57岁女性，有6个月间歇性上腹部隐痛和消化不良病史。随后的上消化道内镜检查发现一个易碎肿块，位于胃窦远端和幽门环之间。活检显示为肠型腺癌。新辅助化疗后行胃大部切除术。大体检查发现，在胃窦远端前壁和靠近小弯的幽门环处有一个大的不规则斑块样肿瘤病变，大小为5.6×4.8×1.0cm。切除胃的组织病理学检查显示，斑块样病变主要由黏膜下层大量异常粗大和迂曲的动脉组成。黏膜下层纤维化增加导致隆起斑块形成。肠型腺癌主要局限于黏膜层，有局灶性黏膜下层和固有肌层受累。胃大部切除术后一周患者出院，出院17个月后存活良好，无重大并发症。
这是首例胃窦远端区域存在与进展期胃癌共存的肿块样Dieulafoy病病例。该病例突出了内镜医师在黏膜切除或活检后可能遇到危及生命的胃出血的可能性。
