PMC3566470_01
(A) Endoscopy revealed two large round, protruding masses in the antrum without a mucosal abnormality. (B) Endoscopic ultrasonography showed two large cystic lesions containing nonhomogenous mixed echoic masses in the proper muscle layer, without nearby lymph node enlargement. (C) Computed tomography revealed a -3.1 cm sized multilocular cystic mass in the submucosal portion of the pylorus.
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F1
The biopsy sample obtained from the lesion at the other clinic was not diagnosed histologically as malignant, and repeat endoscopy at our hospital showed two round, large protruding masses in the antrum with partial obstruction, but without a mucosal abnormality (Fig. 1A). Endoscopic ultrasonography (EUS) revealed two large cystic lesions with nonhomogenous mixed echoic masses in the proper muscle layer, without nearby lymph node enlargement (Fig. 1B). Computed tomography (CT) also depicted the lesions observed by EUS (Fig. 1C).
(A) Cross section showing tumor infiltration into proper muscle and subserosa with normally appearing overlying mucosa. (B) The tumor was located under the intact mucosa (H&E, x12.5). (C) The tumor showing focal papillary growth and extracelluar pools of mucin (H&E, x100).
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F2
Microscopic examination revealed the cancer tissue was predominantly located in the submucosal and proper muscle layers (Fig. 2B). The pathologic diagnosis was mucinous adenocarcinoma and the lesion was found to have invaded the subserosa, and no lymph node was excised (Fig. 2C).
PMC3566470_02
(A) Endoscopy revealed an extrinsic mass effect in the lesser curvature of the midbody, and there was redness of mucosa around the lesion. However there was no evident erosion. (B) Computed tomography revealed a -5 cm sized mass with partial necrotic change in the lesser curvature side of the stomach body and multiple lymphadenopathy.
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F3
Endoscopy performed at the other hospital showed an extrinsic mass effect in the lesser curvature of the midbody without mucosal lesion (Fig. 3A). CT showed a well-circumscribed, exophytic, submucosal 5 cm tumor in the lesser curvature of the midbody, partial necrosis inside the mass, and lymph node enlargement around the lesion (Fig. 3B).
(A) The mucosal surface is slightly red in comparison with the surrounding gastric mucosa but no erosion is evident. (B) On cross section, the tumor was found to have infiltrated subserosa. The tumor had a brownish tan color and necrotic change was observed in its center. (C) Low power histologic examination reveals most of the cancer cells are covered with noncancerous epithelium (H&E, x12.5).
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F4
Radical total gastrectomy with D2 lymph node dissection was undertaken and there was a round bulging of the mass in the lesser curvature of midbody and the mucosal surface is slightly red in comparison with the surrounding gastric mucosa but no erosion is evident (Fig. 4A), and gross findings showed tumor infiltration of subserosa (Fig. 4B). The histopathological diagnosis was mucinous adenocarcinoma and there was no mucosal involvement of the carcinoma microscopically (Fig. 4C).