[Extremely well-differentiated adenocarcinoma (EWDA)]

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Extremely well-differentiated adenocarcinoma of the stomach, also known as “WHYX’ lesion is characterized by surface maturation and mimics intestinal metaplasia (IM). It is very rare, comprising 0.1% of well-differentiated adenocarcinoma of the stomach. Pathologically, it is difficult to diagnose this lesion because it mimics a complete-type intestinal metaplasia

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We divided our ESD specimen into 17 EWDA lesions and 855 non-EWDA lesions. EWDA patients were younger and the macroscopic appearance was usually flat or depressed. There was a significant discrepancy between endoscopic size and the pathologic size. It is much bigger in the pathology than in the endoscopy.

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This is a typical case of depressed type of EWDA. In the resected specimen, the tumor was much bigger than the depressed area.

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Reference: Kang KJ (SMC). Endoscopy 2012:44:949-952