PMC4246919_01
Stomach X-ray of the patient, indicating poor distension of the gastric body.
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However, X-ray examination indicated reduced gastric distension, as well as deformation of the stomach, which exhibited a leather bottle-like appearance (Fig. 1).
Endoscopic images of; (A) the primary depressed lesion at the posterior wall of the gastric antrum and (B) the crossed folds with a waffle-like appearance on the greater curvature of the upper gastric body.
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Additionally, endoscopy revealed an ulcerative lesion covered by a white necrotic substance on the posterior wall of the antrum (Fig. 2A) and severe luminal narrowing, with poor distension of the lower gastric body. The folds of the gastric antrum were flexible, stretched smoothly, and crossed one another, resulting in a waffle-like appearance on the greater curvature of the upper gastric body (Fig. 2B).
(A) Resected specimen. Red arrows indicate the primary depressed lesion and the black arrows indicate the areas of cancer invasion. (B) Microscopic image, revealing the primary lesion to be a poorly differentiated adenocarcinoma containing signet ring cells (stain, hematoxylin and eosin; magnification, x400).
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The resected specimen revealed the wall thickening and crossing folds of the gastric body (Fig. 3A) that were previously observed by endoscopy. Microscopic examination revealed that cancer cells had spread throughout the upper gastric body and had infiltrated the vessels in the submucosa, predominately into the muscularis propria, and marginally into the serosa (Fig. 3B).