Wada Kaoru, Tazawa Hirofumi, Komo Toshiaki, Hadano Naoto, Onoe Takashi, Sudo Takeshi, Shimizu Yosuke, Kuraoka Kazuya, Suzuki Takahisa, Tashiro Hirotaka
Department of Internal Medicine, National Hospital Organization, Kure Medical Center, Chugoku Cancer Center, 3-1 Aoyama, Kure City, Hiroshima, 737-0023, Japan.
Department of Surgery, National Hospital Organization, Kure Medical Center, Chugoku Cancer Center, 3-1 Aoyama, Kure City, Hiroshima, 737-0023, Japan.
Int J Surg Case Rep. 2020;71:327-330. doi: 10.1016/j.ijscr.2020.05.050. Epub 2020 May 29.
We experienced an extremely rare case of gastric adenocarcinoma wrapped by leiomyoma.
A 65-year-old man had an abnormality (filling defect) of the upper gastrointestinal series in his first medical checkup five years prior. Esophagogastroduodenoscopy detected a 10 mm submucosal tumor-like lesion in the greater curvature of the upper gastric remnant body. Despite repeated biopsy from the lesion, there was no sign of malignancy. A delle was observed on the top of the tumor at another visit five year after the first and a biopsy specimen revealed poorly differentiated adenocarcinoma. Therefore, laparoscopic gastrectomy was performed. Histological assessment revealed a 28 × 22 mm elevated lesion with a slight depression. Microscopically, papillary adenocarcinoma was observed at the submucosa with a solitary heterotopic gastric gland adjacent to the lesion. The final diagnosis was papillary adenocarcinoma arising from a solitary heterotopic gastric gland in the leiomyoma. No recurrence has occurred during a follow-up of two and a half years after surgery.
This is the first report of gastric adenocarcinoma arising from a submucosal tumor.
我们遇到了一例极为罕见的被平滑肌瘤包裹的胃腺癌病例。
一名65岁男性在五年前的首次体检中，上消化道造影显示有异常（充盈缺损）。食管胃十二指肠镜检查发现胃残体上部大弯处有一个10毫米的黏膜下肿瘤样病变。尽管对该病变进行了多次活检，但未发现恶性迹象。首次检查五年后的另一次就诊时，在肿瘤顶部观察到一个溃疡，活检标本显示为低分化腺癌。因此，进行了腹腔镜胃切除术。组织学评估显示有一个28×22毫米的隆起病变，伴有轻微凹陷。显微镜下，在黏膜下层观察到乳头状腺癌，病变附近有一个孤立的异位胃腺。最终诊断为平滑肌瘤中孤立异位胃腺起源的乳头状腺癌。术后两年半的随访期间未发生复发。
这是首例关于起源于黏膜下肿瘤的胃腺癌的报告。
