背景:粘膜下肿瘤(SMT)样胃癌是罕见的,几乎所有病例都接受了根治性手术治疗,因为粘膜下层通常被肿瘤细胞深度侵入,或者因为SMT样胃癌的组织病理学类型未分化或低分化。几年来,尚未发布有关仅通过内镜切除术治愈的SMT样胃癌或此类肿瘤的内镜特征变化的报告。
方法:我们描述了一例例外情况:一名53岁的男性,在胃窦通过食管胃十二指肠镜检查(EGD)发现了一个1.5cm大小的SMT样病变,并覆盖了正常的粘膜。内窥镜超声(EUS)可视化均匀,由第二超声层引起的界限良好的低回声病变,并伴随着第三超声层的细微消失。最初的内镜活检为肿瘤阴性。患者拒绝接受侵入性手术,随后失去了随访。在初次发现三年后,EGD显示病变明显红斑,在初次EGD后4年,它的大小增加到1.8cm,并出现中央性溃疡和异质EUS回声。最后,进行内镜黏膜下剥离术(ESD),组织病理学检查显示,中分化腺癌轻微侵犯粘膜下层(浸润深度169μm),但无淋巴管浸润,切缘阴性。幸运的是,不需要额外的手术治疗.他在ESD后随访了4年,没有任何局部或远处复发的证据。
结论:本报告描述了一例极为罕见的早期胃癌,表现为SMT,在治疗延迟4年后通过ESD治愈,以及在此期间发生的内镜改变。该报告强调了在临床实践中遇到SMT时考虑胃癌可能性的重要性。
BACKGROUND: Submucosal tumor (SMT)-like gastric cancer is rare, and almost all cases undergo curative surgical treatment because the submucosal layer is usually deeply invaded by tumor cells or because histopathologic types of SMT-like gastric cancer are undifferentiated or poorly differentiated. No report has been issued on an SMT-like gastric cancer cured by endoscopic resection alone or on changes in the endoscopic features of this type of tumor over several years.
METHODS: We describe an exceptional
case of a 53-year-old male with a 1.5 cm-sized SMT-like lesion covered by normal-appearing mucosa discovered by esophagogastroduodenoscopy (EGD) at the gastric antrum. Endoscopic ultrasound (EUS) visualized a homogeneous, well-circumscribed hypoechogenic lesion arising from the second sonographic layer with associated subtle obliteration of the third sonographic layer. Initial endoscopic biopsy was negative for neoplasm. The patient refused to undergo an invasive procedure and was subsequently lost to follow-up. Three years after initial detection, EGD revealed the lesion had become markedly erythematous, and at 4 years after initial EGD it had increased in size to 1.8 cm and developed a central ulcer and a heterogeneous EUS echo. Finally, endoscopic submucosal dissection (ESD) was performed, and histopathologic examination revealed a moderately differentiated adenocarcinoma had minutely invaded the submucosal layer (invasion depth 169 μm) but without lymphovascular invasion and with negative resection margins. Fortunately, no additional surgical treatment was required. He has been followed for 4 years after ESD without any evidence of local or distant recurrence.
CONCLUSIONS: This report describes an extremely rare
case of early gastric cancer presenting as SMT that was cured by ESD after a treatment delay of 4 years and the endoscopic changes that occurred during this period. The report highlights the importance of considering the possibility of gastric cancer when SMT is encountered in clinical practice.