Aparato Digestivo, Hospital Universitario de Cabueñes, España.
Aparato Digestivo, Hospital de Sierrallana.
Rev Esp Enferm Dig. 2024 Aug;116(8):442-443. doi: 10.17235/reed.2023.9364/2022.
We present the case of a 67-year-old woman referred to our outpatient clinic presenting dyspepsia. Gastroscopy was performed, showing antral gastritis. Random biopsies were taken, being positive for poorly differentiated Lauren's diffuse gastric adenocarcinoma. Narrow-band imaging gastroscopy was performed, combining random and targeted biopsies, with negative results. The study was completed with echoendoscopy and thoraco-abdominal-pelvic CT scan, showing no relevant pathological findings. Control endoscopic was performed after 12 months, showing no macroscopic lesions. Random biopsies were repeated, being positive for diffuse gastric adenocarcinoma. Gastroscopy with conventional chromoendoscopy was performed, showing a completely flat area of approximately 2cm of diameter in the body-antrum junction, in the greater curvature; it was well delimited and no indigo carmine staining was observed (Figure 1). Electronic magnification was performed, showing disruption of the crypt pattern and aberrant neovessels (Figures 2 and 3). Targeted biopsies were taken, being positive for poorly differentiated gastric adenocarcinoma. The case was discussed in a multidisciplinary session and subtotal gastrectomy was performed. Magnification endoscopy offers a better performance diagnosing early gastric cancer than white light endoscopy. [1] It allows the identification of patterns that can predict malignancy, such as distortion of the mucosal glandular pattern or aberrant proliferation of neovessels. [2] Once the diagnosis has been established, assessing the depth of invasion has great clinical relevance, as it guides therapeutic decisions. Works such as that of Zhou et al. [3] underline the usefulness of linear echoendoscopy in this process.
我们报告了一例 67 岁女性因消化不良就诊于我院门诊的病例。行胃镜检查，提示胃窦炎。随机活检阳性，符合低分化 Lauren 弥漫型胃腺癌。行窄带成像胃镜检查，联合随机和靶向活检，结果阴性。研究还包括超声内镜和胸腹盆 CT 扫描，未发现相关病理发现。12 个月后行内镜控制检查，未见宏观病变。重复随机活检，仍为弥漫型胃腺癌阳性。行常规染色内镜检查，胃体-窦交界处大弯侧约 2cm 直径的完全平坦区域，边界清楚，未见靛胭脂染色（图 1）。行电子放大，显示隐窝模式破坏和异常新生血管（图 2 和 3）。行靶向活检，提示低分化胃腺癌。该病例在多学科会议上进行了讨论，并进行了胃次全切除术。放大内镜在诊断早期胃癌方面的表现优于白光内镜。[1]它可以识别出可以预测恶性肿瘤的模式，如黏膜腺模式的扭曲或新生血管的异常增殖。[2]一旦诊断确立，评估浸润深度具有重要的临床意义，因为它指导治疗决策。Zhou 等人的工作。[3]强调了线性回声内镜在这一过程中的有用性。
