PMC6831772_01
(a) Findings at upper gastrointestinal endoscopy seven years prior to this presentation. There is a 10 mm polyp in the gastric cardia. Biopsy was not performed based on its benign appearance (b) Findings at the latest endoscopy. A polyp with an irregular surface and depressed appearance at the top was found in the same area of the stomach. (c) Endoscopic ultrasound revealed possible invasion into the surface of submucosa.
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Seven years previously, she underwent upper digestive endoscopy which showed a 10 mm polyp in the gastric cardia (Fig. 1a). A polyp was again seen in the gastric cardia and had increased in size (Fig. 1b). Endoscopic ultrasonography suggested tumor invasion into the surface of submucosa (Fig. 1c). Deeper invasion to the submucosal layer was suggested by the depressed appearance of the polyp (Fig. 1b) and pathological findings of signet ring cell carcinoma.
(a) The head of the polyp is replaced by adenocarcinoma. Both signet ring cell adenocarcinoma and poorly differentiated adenocarcinoma are surrounded by hyperplastic epithelium (Loupe image, Hematoxylin and eosin stain). (b) Signet ring cell carcinoma component (A), poorly differentiated adenocarcinoma (B) and hyperplastic epithelium (C) are seen (x100, Hematoxylin and eosin stain). (c) Lymphatic invasion is shown by Elastica van Gieson stain. The red circle shows a vessel filled with tumor cells (x400, Elastica van Gieson).
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The specimen revealed both signet ring cell carcinoma and poorly differentiated adenocarcinoma surrounded by hyperplastic epithelium in the head of the polyp (Fig. 2a, b). Although the carcinoma was limited to the mucosal layer, lymphatic invasion was found on the Elastica van Gieson stain (Fig. 2c).