An 80-year-old male with a history of type II diabetes treated with insulin, lower face AMI and chronic liver disease secondary to alcoholism.
At the end of 2002, in the context of a microcytic anemia study, a gastroscopy was performed, in which the presence of two ectopic tissue sheets that ascended about 20 mm from the Z line was detected.
Biopsies were taken from the ointments that confirmed the presence of intestinal metaplasia without dysplasia.
Immunohistochemical staining for p53 (DAKO Diagnostics®, Glostup, Denmark) was considered negative.
Regarding anemia, the patient was finally diagnosed with idiopathic myelofibrosis.
In the following year, due to recurrence of anemia and clinical deterioration of the patient, endoscopy was repeated, showing a peptic gastric ulcer and the already known legumes, with the same macroscopic characteristics.
Biopsies at this time showed the presence of intestinal metaplasia with dementia.
The IHC for p53 was positive with mild intensity and expression in more than 30% of epithelial cells.
Given the patient's age and clinical situation, regulated endoscopic control is devoid.
In September 2004, endoscopy was repeated for swallowing discomfort and postprandial vomiting.
On this occasion, an elevated, irregular and friable area of 4 mm diameter biopsied was observed on one of the legumes.
The conventional pathological study showed DAG and IHC staining showed positivity in more than 90% of epithelial cells.
The patient underwent surgery but finally the high surgical risk was disregarded.
Two months later the endoscopy was repeated and showed a 12 mm ulcerated lesion with raised edges suggestive of a neoplasic process.
The pathological study confirmed the diagnosis of adenocarcinoma.
