Department of Surgery, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan.
Department of Gastroenterology, Japanese Red Cross Takayama Hospital, 3-11 Tenman-machi, Takayama-shi, Gifu, 506-8550, Japan.
World J Surg Oncol. 2022 Apr 29;20(1):136. doi: 10.1186/s12957-022-02605-2.
Invasion is more likely to occur in gastric cancer affecting larger areas. Poorly differentiated adenocarcinoma tends to invade deep. The cardiac region prefers submucosal invasion because the submucosa is coarser than the other regions.
A 75-year-old man presented with a chief complaint of abdominal discomfort and weight loss. Esophagogastroduodenoscopy revealed an irregular ulcerative lesion with partial redness of the upper body and lesser curve of the stomach. A continuous shallow depressed lesion invaded the abdominal esophagus by approximately 40 mm. Poorly differentiated adenocarcinomas (por, sig) were observed on biopsy. Grossly, the cancer appeared to extend into the muscle layer; however, we could not confirm invasion into the muscle layer in our biopsy tissue. We diagnosed the lesion as a superficial spreading type of advanced gastric cancer and performed a total gastrectomy, D2-lymph node dissection (spleen preservation), Roux-en-Y reconstruction, and cholecystectomy. Postoperative histopathological examination revealed extensive infiltration of poorly differentiated adenocarcinoma (90 mm × 55 mm), and all were intramucosal lesions. The final pathological diagnosis was T1a, N0, M0, and Stage IA. The postoperative course was uneventful and the patient was discharged on postoperative day (POD) 11. Five years have passed since the operation, and the patient is alive without recurrence.
We encountered a case of gastric carcinoma in which poorly differentiated adenocarcinomas expanded extensively. All lesions were intramucosal.
侵犯更可能发生在影响较大区域的胃癌中。低分化腺癌往往倾向于深层侵犯。心区更喜欢黏膜下侵犯，因为黏膜下层比其他区域更粗糙。
一名 75 岁男性，主要症状为腹部不适和体重减轻。食管胃十二指肠镜检查显示上半身和胃小弯的不规则溃疡性病变，部分发红。一个连续的浅凹陷性病变侵犯了腹部食管约 40 毫米。活检显示低分化腺癌（por，sig）。大体上，癌症似乎延伸到肌肉层；然而，我们无法在活检组织中确认侵犯到肌肉层。我们将病变诊断为进展期胃癌的浅表扩散型，并进行了全胃切除术、D2 淋巴结清扫术（保留脾脏）、Roux-en-Y 重建术和胆囊切除术。术后组织病理学检查显示广泛浸润的低分化腺癌（90mm×55mm），均为黏膜内病变。最终的病理诊断为 T1a、N0、M0 和ⅠA 期。术后过程顺利，患者于术后第 11 天出院。手术后已经过去了 5 年，患者仍然存活，没有复发。
我们遇到了一例广泛扩展的低分化腺癌胃癌病例。所有病变均为黏膜内病变。
