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Superficial spreading type of early gastric cancer with diagnostic difficulty and positive surgical margin: a case report

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Abstract

An 83-year-old man visited our hospital because of difficulty swallowing. Gastroscopy revealed multiple ulcers and a reddish depression in the lesser curvature of the middle stomach. The initial biopsy showed regenerative atypia, so a gastroscopy was repeated every 3 months thereafter because of suspected malignancy. A biopsy performed 12 months after the initial gastroscopy revealed a well-differentiated adenocarcinoma. After determination of the planned oral resection line by two negative biopsies, laparoscopic distal gastrectomy was performed. The resected specimen showed a 0 − IIa + IIc lesion composed of well-to-moderately differentiated tubular adenocarcinoma, including hand-shaking-type gastric cancer. The oral resection margin was positive due to widespread mucosal extension; therefore, an additional total gastrectomy was needed. Cases of well-differentiated adenocarcinoma and its superficial extension may be difficult to diagnose via endoscopy and biopsy.

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Funding

This work was supported by a grant from the Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Research Grant to KI. The funders played no role in the study design, data collection, data analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan

    Koyo Ikeda, Hidemasa Nagai, Hideo Miyake, Yuichiro Yoshioka, Mika Katayama & Norihiro Yuasa

  2. Department of Gastroenterlogy, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan

    Takahiro Marukawa

  3. Department of Pathology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan

    Masafumi Ito, Masahiko Fujino, Hideki Murakami & Ayami Kiriyama

Authors
  1. Koyo Ikeda
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  2. Hidemasa Nagai
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  3. Hideo Miyake
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  8. Masafumi Ito
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  11. Ayami Kiriyama
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Contributions

All the authors contributed to the report’s conception and design. Material preparation and data collection were performed by KI, HN, HM, YY, MK, and NY. Pathological examination was performed by MI, MF, HM and AK. The first draft of the manuscript was written by KI, and all the authors read and approved the final draft of the manuscript.

Corresponding author

Correspondence to Norihiro Yuasa.

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Conflict of interest

Koyo Ikeda, Hidemasa Nagai, Hideo Miyake, Yuichiro Yoshioka, Mika Katayama, Norihiro Yuasa, Masafumi Ito, Masahiko Fujino, Hideki Murakami and Ayami Kiriyama declare that they have no conflict of interest.

Ethical considerations

All the procedures complied with the Ethical Standards of the Responsible Committees on Human Experimentation (Institutional and National) and with the 2008 version of the Declaration of Helsinki.

Human rights

All the procedures followed have been performed in accordance with the Ethical Standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent for this report was obtained from the patient.

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Ikeda, K., Nagai, H., Miyake, H. et al. Superficial spreading type of early gastric cancer with diagnostic difficulty and positive surgical margin: a case report. Clin J Gastroenterol 15, 537–546 (2022). https://doi.org/10.1007/s12328-022-01610-y

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  • DOI: https://doi.org/10.1007/s12328-022-01610-y

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