Melena. Initial biopsy false negative. EndoTODAY 이준행

[Gastric cancer 847. Melena. Initial biopsy false negative.]

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A 45 years old lady was referred due to gastric cancer.

A few months ago, she developed melena and the endoscopic biopsy was negastive for malignancy. PPI treatment was done. In the follow up endoscopy 2 months later, the biopsy was poorly differentiated adenocarcinoma.

Biopsy is not 100% sensitive. It is especially true in the setting of bleeding. Careful interpretation of the endoscopic finding is very important to determine the timing of follow-up endoscopy. If cancer is suspected, 2nd endoscopy can be recommended as soon as possible.

Radical surgery was done.

Stomach, subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at low body and posterior wall
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 3.2x3 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 1.5 cm, distal 9 cm
8. Lymph node metastasis : no metastasis in 35 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. AJCC stage by 8th edition: pT3 N0