case_images: PMC11350541_01
case_images: A 0-Isp type lesion on the posterior wall of the gastric antrum (a), irregular microstructure pattern, irregular microvessels arrangement pattern, and demarcation line were observed under the magnifying endoscopy combined with narrow-band images (b), the submucosa underlying the lesion was continuous and intact based on endoscopic ultrasonography inspection (c), hematoxylin-eosin staining of the biopsy tissue taken from the lesion was confirmed as high-grade intraepithelial neoplasia (d).
case_images: 10.1177_11795476241271552-fig1.jpg
case_images: PMC11350541_01_10.1177_11795476241271552-fig1.jpg
case_images: fig1-11795476241271552
case_images: We found a 0-Isp type lesion with a size of 22 mm x 20 mm on the posterior wall of the gastric antrum (Figure 1a), at the same time, a fading type 0-IIa lesion in the angular incisure of the stomach was detected. The surface microstructure and microvessels of the 2 lesions were quite different from the surrounding normal mucosa under the observation of magnifying endoscopy combined with narrow-band images (Figure 1b). The submucosa below the lesion located in the gastric antrum was continuous and intact based on endoscopic ultrasonography inspection (Figure 1c). Hematoxylin-eosin staining of the biopsy tissue taken from the 2 lesions were confirmed as high-grade intraepithelial neoplasia (HGIN) by experienced pathologist (Figure 1d).
case_images: An active outflux of blood at the top of the 0-Isp type lesion surrounded by a large quantity of fresh red blood clots (a), both of lesions were peeled by emergency ESD (b), freshly isolated specimens and formalin-fixed specimens from the gastric antrum (c, d). The blood vessel stump on the top of the tumor could be clearly distinguished by the naked eye (white arrow).
case_images: 10.1177_11795476241271552-fig2.jpg
case_images: PMC11350541_01_10.1177_11795476241271552-fig2.jpg
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case_images: So the second gastroscopy was performed, and unexpectedly, there was an active outflux of blood at the top of the 0-Isp type lesion located on the gastric antrum surrounded by a large quantity of fresh red blood clots (Figure 2a). We also dissected the EGC in the angular incisure of the stomach (Figure 2b). In the isolated specimen from the gastric antrum, the blood vessel stump on the top of the tumor could be clearly distinguished by the naked eye (Figures 2c and d).
case_images: The abnormal vessels at the top of the tumor were excessively proliferating and unevenly distributed (a and b), and the average diameter reached 140 to 160 mum (c). The vessels in non cancerous epithelium were evenly distributed, uniform in shape, and only 30 to 45 mum in diameter (d), while in another specimen, the diameter of the tumor blood vessels was limited within a range of 40 to 80 mum (e).
case_images: 10.1177_11795476241271552-fig3.jpg
case_images: PMC11350541_01_10.1177_11795476241271552-fig3.jpg
case_images: fig3-11795476241271552
case_images: A (eCuraA) in the 6th Japanese Gastric Cancer Association (JGCA) guidelines.   Unusually, thick and abundant blood vessels extending from the inside to the surface of the tumor corresponded accurately to the active bleeding site under the endoscopy (Figure 3a and b). After ESD, the patient recovered well with intravenous infusion of PPI and oral mucosal protectants, and was discharged 5 days later.