Gastric cancer. EndoTODAY

[Gastric cancer 818. AGC at the gastric angle]

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A 80 years old lady was referred due to suspicious gastric cancer. The outside biopsy was "high grade dysplasia with atypical glands. This may be associated with well differentiated adenocarcinoma, but not diagnostic."

Repeated endoscopic biopsy was "M/D tubular adenocarcinoma." It was very difficult to take a good endoscopic picture for this lesion. The distance between the tip of the endoscope and the lesion was too short. Taking pictures of a cancer lesion at the gastric angle may be difficult - especially for a wall thickening lesion. In addition, gastric angle can be a blind area.

Surgery was done.

Stomach, subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at body and lesser curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 5.5x4.3 cm
6. Depth of invasion : invades serosa (pT4a)
7. Resection margin: free from carcinoma, safety margin: proximal 1.4 cm, distal 3.7 cm
8. Lymph node metastasis : no metastasis in 40 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. Peritoneal cytology : not done
13. AJCC stage by 8th edition: pT4a N0