Gastric cancer. EndoTODAY

[Gastric cancer 794. Difficulty of guessing the depth of invasion]

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ESD was recommended of the adenoma with high grade dysplasia of the angle, but the patient did not come. Twenty months later, he came back again and the biopsy was tubular adenoma with high grade dysplasia and suspicious carcinomatous transformation. I recommende surgery.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at body and lesser curvature
2. Gross type : EGC type IIa
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size : 3.5x3.0 cm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 2.3 cm, distal 3.0 cm
8. Lymph node metastasis : no metastasis in 24 regional lymph nodes (pN0) (0/24: "12a", 0/1; "11p", 0/1; "9", 0/1; "8a", 0/4; "7", 0/6; "6", 0/1; "5", 0/1; "4sb", 0/0; "4", 0/6; "3", 0/2; "1", 0/1)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0

The final pathology was EGC as I guessed. To my surprise, however, the depth of invasion was lamina propria.