PMC6911759_01
Endoscopic features of the early EBV GC lesion. a: White-light imaging observation. A superficial depressed-type early gastric cancer lesion was detected in the middle of the gastric body. The diameter of the lesion was almost 10 mm. b: Narrow-band imaging revealed the irregular microvascular pattern of the lesion. c: Indigo-carmine dye contrast observation. A shallow, reddish depressed lesion was clearly visible. These ordinary endoscopic observations detected no signs of submucosal invasion, and the lesion was endoscopically staged as intramucosal cancer. d: However, thin-probe endoscopic ultrasonography detected a small hypoechoic mass less than 1 mm in diameter in the hyperechoic third layer, corresponding to the submucosal layer of the gastric wall, which was staged as being borderline invasion between the intramucosal layer and invading into the submucosa.
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Given these findings on the pretherapeutic examination, his second GC lesion was evaluated as a candidate for the extended criteria of ESD (Fig. 1).
ESD for the early EBV GC lesion. Based on the results of the pretherapeutic examination, his GC lesion was considered a candidate for the extended criteria of ESD. a: ESD performance. b: There was no residual tumor after en bloc resection. c: ESD specimen. d: The tumor was located in the red-lined area.
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We therefore performed en bloc resection using ESD for his second GC lesion (Fig. 2).
Pathological features of ESD specimen. a: Low-power microscopic picture of Hematoxylin and Eosin staining. The tumor was 10 mm in diameter and invaded 0.8 mm into the submucosal layer. The pathological type was CLS, and lymphovascular infiltration was negative. b: Middle-power microscopic picture of EBER1 ISH. c: High-power microscopic picture of EBER1 ISH. Almost all tumor cell nuclei were positive for EBER1 ISH. The lesion was confirmed to be EBV GC.
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Almost all tumor cell nuclei were EBER1-positive, and his second GC lesion was confirmed to be EBV GC (Fig. 3).