PMC5849812_01
Endoscopic Findings.. 1A: A large pedunculated polyp with prolapse into the duodenal bulb was found.. 1B: The prolapse was easily corrected.. 1C: The tumor size was about 3.5 cm.
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U/ml were classified as anti-Hp IGG antibody positive. Upper gastrointestinal endoscopy was performed, and a large (3.5 cm) pedunculated polyp with prolapse into the duodenal bulb was found (Fig. 1).
Findings of contrast-enhanced computed tomography.. Abdominopelvic computed tomography (CT) showed the pedunculated polyp with prolapse into the duodenal bulb with no evidence of distant metastasis or lymph node metastasis.
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Abdominopelvic computed tomography (CT) showed the pedunculated polyp with prolapse into the duodenal bulb without evidence of distant metastasis or lymph node metastasis (Fig. 2). [fluorine-18]-fluorodeoxy-glucose (18F-FDG)-positron emission tomography (PET)/computed tomography (CT) imaging showed high 18F-FDG uptake, suggesting the possibility of advanced gastric cancer (Fig. 3).
[fluorine-18]-fluorodeoxy-glucose (18F-FDG)-positron emission tomography (PET)/computed tomography (CT).. 18F-FDG- PET/CT imaging showed high 18F-FDG uptake, suggesting the possibility of advanced gastric cancer.
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Abdominopelvic computed tomography (CT) showed the pedunculated polyp with prolapse into the duodenal bulb without evidence of distant metastasis or lymph node metastasis (Fig. 2). [fluorine-18]-fluorodeoxy-glucose (18F-FDG)-positron emission tomography (PET)/computed tomography (CT) imaging showed high 18F-FDG uptake, suggesting the possibility of advanced gastric cancer (Fig. 3).
ESD.. A dual knife (Electrosurgical Knife [KD-650L]; Olympus) was used for marking, mucosal incision, and submucosal dissection, and hyaluronic-acid containing solution was used as a submucosal fluid cushion. The tumor was resected in an en bloc fashion.
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ESD was completed without complications, and the tumor was resected in an en bloc fashion (Fig. 4).
Pathohistological findings.. Adenocarcinoma, tub1, pT1a(M), ly(-), v(-), UL(-), 33 x 35 x 20 mm in size. A) A cut section of the polypoid lesion (HE stain, loupe image),. B) Atypical foveolar epithelium in the top of the polyp (HE stain, object lensx20),. C) Fusiogenic atypical glands in the bottom of the polyp (HE stain, object lens x20),. D) No stalk invasion, stump free, pHM0, pVM0. (HE stain, object lens x2),. E) Immunohistochemical stain of Desmin, no invasion to muscularis mucosae of the stalk (object lens x2).
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The pathohistological diagnosis was early gastric cancer (33 x 35 x 20 mm, well differentiated tubular adenocarcinoma [tub1], pT1a[M], ly[--], v[--], UL[--], pHM0, pVM0 [Fig. 5]) according to the Japanese classification of gastric carcinoma.
Upper gastrointestinal endoscopy performed 9 month after the ESD.. No local recurrence was found by the upper gastrointestinal endoscopy performed 9 month after the ESD.
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After the patient discharged from our hospital, upper gastrointestinal endoscopy (9 month after the ESD: Fig. 6) and abdominopelvic CT (12 month after the ESD) was performed and revealed no recurrence.